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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. [1] This bill is called a claim. [2]
The company was founded in 1999, by Douglas Kegler, who previously used to code dental and medical billing programs. [7] In April 2008, the company changed its former name XGear Technologies, Inc. to CollaborateMD, Inc. As of 2017, the company has processed over $46 billion worth of medical claims for 20 million patients. [8]
Catamaran Corporation (formerly SXC Health Solutions) is the former name of a company that now operates within UnitedHealth Group's OptumRX division (since July 2015). It sells pharmacy benefit management and medical record keeping services to businesses in the United States [3] and to a broad client portfolio, including health plans and employers. [4]
Change Healthcare is a key player in the U.S. healthcare system that depends heavily on insurance, processing about 50% of medical claims for around 900,000 physicians, 33,000 pharmacies, 5,500 ...
In May 2012, the company acquired TC3 Health, a cost containment provider, including payment integrity and out-of-network claims cost management, to U.S. healthcare payers. [26] In June 2013, the company acquired Gold Health Systems, a healthcare management organization that specializes in providing pharmacy benefits and related services ...
The risk of loss remains with the employer, and not with the TPA. An insurance company may also use a TPA to manage its claims processing, provider networks, utilization review, or membership functions. While some third-party administrators may operate as units of insurance companies, they are often independent. [citation needed]
The company was still working on resuming operations that were disrupted by the February hack, and on Tuesday said it expects a hit of up to $1.6 billion this year from the cyber attack.
In the United States, health insurance providers often hire an outside company to handle price negotiations, insurance claims, and distribution of prescription drugs. Providers which use such pharmacy benefit managers include commercial health plans , self-insured employer plans, Medicare Part D plans , the Federal Employees Health Benefits ...
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