In ____________ the System Uses Software and a Variety of Techniques

question 7

Short Answer

In ____________ the system uses software and a variety of techniques to identify behaviors that appear inappropriate and compare them with acceptable behaviors.

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Definitions:

Plan Members

Individuals who are enrolled in and receive benefits from a health insurance plan or program.

Explanation of Payment

A detailed description or clarification of why a payment was made and what it covers.

Remittance Advice

A document sent by a payer to a payee, providing details on the payment of an invoice, including information on any adjustments or deductions taken.

Indemnity Plans

Health insurance plans that reimburse the insured for medical expenses regardless of the healthcare provider used.