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Which of the Following Due Process Systems Is Fastest and Least

question 25

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Which of the following due process systems is fastest and least expensive to administer?


Definitions:

Precertification

Refers to obtaining plan approval for services prior to the patient receiving them; refers to seeking approval for a treatment (surgery, hospitalization, diagnostic test) under the patient’s insurance contract.

Specified Outpatient

Specified Outpatient refers to particular outpatient medical treatments or procedures that are predefined under a health plan or policy for coverage or reimbursement.

Coordination of Benefits (COB)

A process in health insurance to determine the order of responsibility when a person is covered by more than one insurance plan, to avoid overlapping payments.

Duplication of Payment

An error or fraud resulting in the repeated payment for a single invoice or service.

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