Published by Pearson (1 March 2013) © 2014
Price Reduced From: $146.65
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SECTION I: INTRODUCTION TO ISSUES RELATED TO HEALTH CLAIMS PROCESSING
1. Introduction to Technical and Legal Issues
2. Resource Manuals and Billing Forms
SECTION II: CONTRACT INTERPRETATION AND ADMINISTRATION
3. Medical Plan Provisions
4. Medical Benefit
SECTION III: MEDICAL CLAIMS EXAMINING GUIDELINES AND PROCEDURES
5. Medical Claims Administration
6. Physician's, Clinical, and Hospital Services Claims
7. Surgery and Anesthesia Claims
8. Medicare and Medicaid
9. Workers' Compensation
10. Managed Care Claims
SECTION IV: MANAGEMENT OF CLAIMS EXAMINING
11. Claims Examination
12. Processing Non-Medicare Claims
13. Processing Medicare Claims
14. Processing Workers' Compensation Claims
SECTION V: APPENDICES