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At this point, the medical service may be approved or rejected, or additional information may be requested. If a service is rejected, the healthcare provider may file an appeal based on the provider's medical review process. [6] [7] In some cases, an insurer may take up to 30 days to approve a request. [8]
Formed in 2011, Optum says that it provides "data and analytics, pharmacy care services, population health, healthcare delivery, and healthcare operations". [82] It is organized into three businesses: OptumHealth – provides primary and secondary care. [82] [83] OptumInsight – provides data analytics, technology, and operations services. [82]
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.
In the United States, a third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. [1] It is also a term used to define organizations within the insurance industry which administer other services such as underwriting and customer service.
By Brendan Pierson (Reuters) - UnitedHealth Group Inc uses an artificial intelligence algorithm that systematically denies elderly patients' claims for extended care such as nursing facility stays ...
OData uses different formats for representing data and the data model. In OData protocol version 4.0, JSON format is the standard for representing data, with the Atom format still being in committee specification stage. For representing the data model, the Common Schema Definition Language (CSDL) is used, which defines an XML representation of ...
An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to ...
AlternativeTo is a website which lists alternatives to web-based software, desktop computer software, and mobile apps, and sorts the alternatives by various criteria, including the number of registered users who have "Liked" each of them on AlternativeTo. [3]