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A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submitted to the payors. [2] 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 department also determines if services and benefits offered by companies are consistent with insurance policy provisions and Ohio law, reviews and approves more than 6,200 company filings per year for life, accident, health, managed care, and property and casualty policy forms and rates. The Director of Insurance, who is appointed by the ...
Medical Mutual of Ohio (MMOH) is an American mutual health insurance company. It is the oldest and largest health insurance company based in Cleveland, Ohio, and serves more than 1.6 million customers. [2] Employing 2,500 people, Medical Mutual is one of the biggest employers in downtown Cleveland. [3]
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:
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Medicaid is a government program in the United States that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant ...
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