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  2. Medical billing - Wikipedia

    en.wikipedia.org/wiki/Medical_billing

    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.

  3. Medical practice management software - Wikipedia

    en.wikipedia.org/wiki/Medical_practice...

    Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.

  4. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...

  5. UnitedHealth unit will start processing $14 billion medical ...

    www.aol.com/news/unitedhealths-change-start...

    By Leroy Leo (Reuters) -UnitedHealth Group said on Friday its Change Healthcare unit will start to process the medical claims backlog of more than $14 billion as it resumes some software services ...

  6. CorVel Corporation - Wikipedia

    en.wikipedia.org/wiki/CorVel_Corporation

    Software development efforts have been focused on the incorporation of artificial intelligence capabilities and workflow management tools in to the claims management systems in order to enable CorVel's unique process. In August 2010, CorVel introduced a provider look up app that can be accessed in the Apple Store and Google Play. This mobile ...

  7. IDX Systems - Wikipedia

    en.wikipedia.org/wiki/IDX_Systems

    Prior to its acquisition by GE Healthcare, IDX had four primary lines of business: . Flowcast was the original application produced by IDX. It is a revenue cycle management system for medium to large physician groups, hospitals, and integrated delivery networks, and includes scheduling, billing and collections modules.

  8. CollaborateMD - Wikipedia

    en.wikipedia.org/wiki/CollaborateMD

    CollaborateMD is a private company that provides cloud-based medical billing and practice management software services for independent medical practices and hospitals. [3] [4] The company's software uses real-time claim submission and built-in edits and integrates with various electronic health records (EHRs).

  9. Evaluation and Management Coding - Wikipedia

    en.wikipedia.org/wiki/Evaluation_and_Management...

    Evaluation and management coding (commonly known as E/M coding or E&M coding) is a medical coding process in support of medical billing. Practicing health care providers in the United States must use E/M coding to be reimbursed by Medicare , Medicaid programs, or private insurance for patient encounters.