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Inpatient Claims - Coggle Diagram
Inpatient Claims
Assessment
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Schedule of Benefits
Is there a better solution for creation/maintenance of rules? 180 alerts at present in pre-run i.e. no rules in the system
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Contracts
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No contracts system (word/pdf docs) creates risk of missed items in assessment. Need to look at improving the linkage b/w providers and claims on the contract data for assessment.
Consultant Contracts
Not all cons contracts are known. Risk of incorrect payments due to lack of transparency on cons contracts. Some cons on the system where the cons type is blank.
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Quality Control
We target claims >€12k but these are often hi-tec. Other criteria might be more valid for quality control. Need to re-evaluate the approach to quality control.
Claims Coding
2-3 yrs behind on coding. Risk on upgrades/pre-existing. Big gap in connected health to understand trends.
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