Medical insurance program_wave 9
Auditing Course
Introduction
○ Medical insurance
○ Basic elements in Health insurance
Requirements of health insurance
○ Provider
○ Policy Holder
○ Automated programs
● Importance of Health Insurance
● Primary benefits of Health Insurance
○ Ambulatory service
○ Emergency services
○ Hospitalization
○ Maternity and Newborn care
○ Mental health services
○ Medications
● Risk factors of Medical Insurance
● Medical Insurance companies
● Types of Insurance companies
○ Third Party Administrator (TPA)
○ Self-Insurance companies
● Departments of an Insurance company
○ Approval
○ Pricelist
○ Indemnity or refund
○ Call-center
○ Provider team
○ Medical analysis
○ Chronic team
○ Resubmission
○ claims
● Types of health insurance plans
○ Individual plans
○ Family plans
○ Senior-citizen plans
○ Critical illness insurance plans
○ Personal accident insurance
○ Maternity plans
● Policies and contract
● Policy details
○ Limits of individual insurance
○ Inpatient limits
○ Outpatient limits
○ Medication limit
○ Dental limit
○ Vision limit
○ Maternity limit
■ Extra pool limit
○ Revenue cycle management (RCM) in medical insurance
○ Medical auditing
○ Claim form
○ Types of rejection
○ Uncovered disease
○ Rejection reasons
○ Debit payment reason
○Hold payment reasons
○ Medical billing
○ Auditing training
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