Claims Adjudication Review : State of Montana 1980
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In our eReader you can find the full English version of the book. Read Claims Adjudication Review : State of Montana 1980 Online - link to read the book on full screen. Our eReader also allows you to upload and read Pdf, Txt, ePub and fb2 books. In the Mini eReder on the page below you can quickly view all pages of the book - Read Book Claims Adjudication Review : State of Montana 1980
What reading level is Claims Adjudication Review : State of Montana 1980 book?
To quickly assess the difficulty of the text, read a short excerpt:
- The master contract does not define customary charges to include the $5.00 variance.
- The master contract is not specific regarding payment for crowns, anesthesia and fluoride treatment for adults.
. Other conclusion - Claim turnaround time appears to be reasonable.
Improvement could be made in documentation of reasons for delay.
RECOMMENDATIONS REGARDING AETNA PMM&Co. makes the following recommendations regarding the Aetna dental plan: . Social Security numbers and treatment dates should be... provided to the State on a monthly basis for eligibility verification audit by the State.
. Aetna should instruct processors to require COB data on all claims prior to processing and to process claims only after a complete review of COB information.
. Aetna claim supervisor should review all processor overrides of system edits.
IV-4 . Aetna should instruct processors to balance charges on the claim form with data entered into the system.
. Aetna and State should agree on contract variances between master contract and claim department administrative procedures.
What to read after Claims Adjudication Review : State of Montana 1980?
You can find similar books in the "Read Also" column, or choose other free books by Montana. Legislative Assembly. Office of the Legislative Auditor to read onlineMoreLess
To quickly assess the difficulty of the text, read a short excerpt:
- The master contract does not define customary charges to include the $5.00 variance.
- The master contract is not specific regarding payment for crowns, anesthesia and fluoride treatment for adults.
. Other conclusion - Claim turnaround time appears to be reasonable.
Improvement could be made in documentation of reasons for delay.
RECOMMENDATIONS REGARDING AETNA PMM&Co. makes the following recommendations regarding the Aetna dental plan: . Social Security numbers and treatment dates should be... provided to the State on a monthly basis for eligibility verification audit by the State.
. Aetna should instruct processors to require COB data on all claims prior to processing and to process claims only after a complete review of COB information.
. Aetna claim supervisor should review all processor overrides of system edits.
IV-4 . Aetna should instruct processors to balance charges on the claim form with data entered into the system.
. Aetna and State should agree on contract variances between master contract and claim department administrative procedures.
What to read after Claims Adjudication Review : State of Montana 1980?
You can find similar books in the "Read Also" column, or choose other free books by Montana. Legislative Assembly. Office of the Legislative Auditor to read onlineMoreLess
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