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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.
In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). [11] Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance.
Advocate Aurora Health (AAH) is a non-profit, faith-based health care system with dual headquarters located in Milwaukee, Wisconsin, and Downers Grove, Illinois.As of 2021, the AAH system has 26 hospitals and more than 500 sites of care, with 75,000 employees, including 10,000 employed physicians. [2]
Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.
Advocate Children's Hospital was formed in 2012 when Hope Children's Hospital in Oak Lawn merged with Lutheran Children's Hospital in Park Ridge. [8] Following a trend for children's hospitals in the Chicago region, Advocate Children's Hospital expanded in 2018 when the hospital added 11 beds to their neonatal intensive care unit. [9]
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Change Healthcare was established in 2007 and based in Brentwood, Tennessee. [5] The company provided healthcare consumer engagement [clarification needed] and health plan cost transparency tools to health plans and large, self-insured employers, [6] across the United States.
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