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Users of Department of Defense's TRICARE Online can use the Blue Button to download their medications, allergies, and lab results as a PDF or text file. [23] Organizations like Medicare or Aetna offer health claims information as a downloadable text file. Using Blue Button, patients have an easy way to retrieve and keep track of their health.
In the 21st century, commercial payers were increasingly using litigation against providers to combat alleged fraud or abuse. [25] Examples included litigation between Aetna and a group of surgical centers over an out-of-network overbilling scheme and kickbacks for referrals, where Aetna was ultimately awarded $37 million. [25]
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.
A variety of different types of health plans serve Medicaid managed care programs, including for-profit and not-for-profit, Medicaid-focused and commercial, independent and owned by health care providers such as community health centers. In 2007, 350 health plans offered Medicaid coverage.
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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.
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