We always say I am healthy but what does being healthy actually means? The term healthy is defined different by different persons. Generally, being healthy means being void of illness or any form of injury. But is this actually true? Can anyone be really free from any form of illness of injury? The answer to this question is no. People are prone to illness or injury but after falling sick what? Then comes the step of visiting the provider. Number of visits (to physician offices, hospital outpatient and emergency departments) is 1.2 billion alone in the US . Also, such visits turns out to be very costly. The only factor that makes it affordable is the health insurance
What is health insurance
According to the Health…show more content… • Concurrent review and discharge planning: The next step involves in reviews of medical necessity and the timeliness if the delivery of medical care till the time of discharge time. It is done in order to check if the doctors carry out their tasks efficiently.
• Retrospective review: In the next step the actual data is monitored and analyses of the data. This data is uses to plan and manage the budget and improve the quality.
• Disease management and case management: The last step involves the case management and disease management. In disease management certain type of patients are considered and they are educated to manage their own illness and improve their quality of life whereas in case management is responsible to integrate the practices and technologies used by leading medical authorities.
Claim process as an part of utilization management
The definition of utilization management states that it is a process that is responsible for evaluating the health care services. Verifying and evaluating the details that comes in during claim is important for the approval of claims. It is only after the verification that the claim is approved and the patient receives the necessary benefits. Claims that take place with the help of UM not only helps in reducing time but also helps in