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Eliminating Healthcare Fraud Through Technology

January 29, 2007

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There are many types of healthcare fraud. It can be driven by healthcare and insurance providers, patients, employers or any combination of the above. Healthcare providers might make claims for services not provided, or overcharge for services they did provide. They might also submit claims for additional or more expensive services than were strictly necessary. […]

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Enterprise-Class 360° Revenue Cycle Management Solutions for the Patient-Centric Provider

January 29, 2007

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Do you consider yourself a progressive provider of care? Do you have reimbursement issues with payers? Tired of broken processes? The Pain If you ask any healthcare organization today what their No. 1 concern is, they will likely answer that they want to provide excellent clinical care for their patients, but at what risk? It […]

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Claims Management and Legacy Integration

November 13, 2005

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In most provider offices today, the patient accounting system is the beginning of the electronic healthcare transaction.When patients arrive, their information is automatically entered or updated in the provider’s patient accounting system. Physician notes on the patient’s examination are reviewed by an assistant who turns key aspects of the patient’s visit into a claim (e.g., […]

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Health Plan Operations in the New World Of Health Care Financing

July 16, 2004

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Introduction Very few market dynamics over the last 20 years have garnered the attention of the health care payer community as has consumer- directed health care. Over the last four to five years, much has been written – positive and negative – about the concept designed to put health care consumers in control of the […]

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Smart Cards

July 16, 2004

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As health plans become more tailored to the needs of consumers and the budgets of employers, new ways of storing and exchanging patient information are making simple work of the often complex rules for coordinating benefits. The following story is an extrapolation of today’s technological capabilities and collaboration initiatives into a future that may be […]

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Pharmacy Automation: Bothwell Regional Health Center Improves Patient Safety, Efficiency and Inventory Control

July 16, 2004

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About Amerinet Amerinet is one of the most innovative and effective health care group purchasing organizations in the United States, leading the industry in flexibility with a commitment to providing supplier choice for its members. Amerinet’s national network of companies – Amerinet Central, Intermountain Health Care and Vector – has set the standard for customer […]

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NEHEN: An Electronic Transaction Exchange for Massachusetts” Health Care System

July 16, 2004

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The New England Health EDI Network (NEHEN) was formed in 1998 by a collaborative of nonprofit payers and providers to implement HIPAA administrative simplification for the region. Three of the provider organizations, Partners Healthcare, CareGroup, and Lifespan helped found NEHEN. Boston Medical Center (BMC) joined in December 1999. UMass Memorial and Children’s Hospital joined in […]

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Payer-Provider Collaboration Increased EDI

July 16, 2004

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HCT: How has Blue Cross Blue Shield Michigan (BCBSM) been able to work with so many in the provider community to get such a high rate of electronic media? Debbie Fritz-Elliott: In the early ’90s, we targeted efforts to significantly raise electronic claims submission rates. With the help of our consulting partners, we examined root […]

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Care Management

July 16, 2004

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Care management is multidimensional, dealing with administrative issues such as authorizations and referrals, providing ongoing support through initial and concurrent clinical reviews to help members/patients receive the appropriate level of care at appropriate time consistent with standard practices, and managing complex and chronic medical conditions.

Care management processes include:

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