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Health Insurance Plan of Greater New York (HIP) was incorporated in 1944 as the first health insurance plan for public service workers. [9] The company was founded by David M. Heyman with the support of New York City mayor Fiorello LaGuardia, who wanted to offer medical services to New Yorkers of “moderate means.” [10] HIP got its first members in 1947.
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Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4] The payor returns the claim back to the medical biller and the biller evaluates how much of the bill the patient owes, after insurance is taken out.
It is up to the application receiving the incoming claim to map the is/is not claims to the may/may not rules of the application. In traditional systems there is often confusion about the differences and similarities between what a user is/is not and what the user may/may not do. Claims-based identity makes that distinction clear.
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Optum serves employers, government agencies, health plans, life science companies, care providers and individuals and families offering products in data and analytics, pharmacy care services, health care operations and delivery, population health management and advisory services. [7]