Claims Adjudication Review : State of Montana 1980
The book Claims Adjudication Review : State of Montana 1980 was written by author Montana. Legislative Assembly. Office of the Legislative Auditor Here you can read free online of Claims Adjudication Review : State of Montana 1980 book, rate and share your impressions in comments. If you don't know what to write, just answer the question: Why is Claims Adjudication Review : State of Montana 1980 a good or bad book?
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- The master contract does not define customary charges to include the $5.00 variance. - The master contract is not specific regarding payment for crowns, anesthesia and fluoride treatment for adults. . Other conclusion - Claim turnaround time appears to be reasonable. Improvement could be made in documentation of reasons for delay. RECOMMENDATIONS REGARDING AETNA PMM&Co. makes the following recommendations regarding the Aetna dental plan: . Social Security numbers and treatment dates should be... provided to the State on a monthly basis for eligibility verification audit by the State. . Aetna should instruct processors to require COB data on all claims prior to processing and to process claims only after a complete review of COB information. . Aetna claim supervisor should review all processor overrides of system edits. IV-4 . Aetna should instruct processors to balance charges on the claim form with data entered into the system. . Aetna and State should agree on contract variances between master contract and claim department administrative procedures.
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