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  2. Medical billing - Wikipedia

    en.wikipedia.org/wiki/Medical_billing

    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.

  3. National Provider Identifier - Wikipedia

    en.wikipedia.org/wiki/National_Provider_Identifier

    A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...

  4. Health insurance in the United States - Wikipedia

    en.wikipedia.org/wiki/Health_insurance_in_the...

    Dental insurance helps pay for the cost of necessary dental care. Few medical expense plans include coverage for dental expenses. About 97% of dental benefits in the United States is provided through separate policies from carriers—both stand-alone and medical affiliates—that specialize in this coverage.

  5. Health maintenance organization - Wikipedia

    en.wikipedia.org/wiki/Health_maintenance...

    The earliest form of HMOs can be seen in a number of "prepaid health plans". In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month. This is considered by some to be the first example of an HMO.

  6. 'Deny, deny, deny': By rejecting claims, Medicare Advantage ...

    www.aol.com/news/deny-deny-deny-repeatedly...

    A Humana spokesman provided this statement: “In our Medicare Advantage hospital contracts, Humana pays rates, on average, that are above fee-for-service Medicare rates.

  7. Revenue cycle management - Wikipedia

    en.wikipedia.org/wiki/Revenue_cycle_management

    The claim is then sent out from the provider to the payer in an ANSI 837 5010 standard format. Denials can be sent back as a response to the claim from the payer stating a specific reason of why the claim cannot be adjudicated. This is where denial management processes help to ensure that there is an immediate resolution to these denials.

  8. Whistleblower Lawsuit Against Humana: Settles Medicare ... - AOL

    www.aol.com/whistleblower-lawsuit-against-humana...

    Last week, Humana Inc (NYSE:HUM) agreed to pay $90 million to the federal government to settle a whistleblower lawsuit alleging fraudulent Medicare Part D bids. The lawsuit, filed by Phillips ...

  9. California Department of Insurance - Wikipedia

    en.wikipedia.org/wiki/California_Department_of...

    In 1979, Chapter 12 of the California Insurance code established the "Bureau of Fraudulent Claims" to investigate criminal insurance violations. In 1980, the fraud investigators became sworn peace officers under Penal Code 830.3(i). In 1988, the Bureau of Fraudulent claims was reclassified as the "Fraud Division."