BA Health Care Online Training
BA Health Care Online Training
BA Health Care Online Training Course Content :
Healthcare Market Overview
- Introduction
- Current healthcare market trend in US
- What is an HMO
- The Industry Outlook
- Trends in Healthcare – Provider Space
- Trends in Healthcare – Payer Space
- Key Players
Healthcare Overview
- Unit Objectives
- Genesis Of Healthcare
- How the industry Works?
- Healthcare pillars
- Members
- Providers
- Benefits
- Claims
- Sales
- External Agents
- Healthcare workflow
- Summary
Members
- Unit Objective
- Introduction
- Insurance Business: An Overview
- Individual and Group Insurance in detail
- Individual Insurance
- How to get individual insurance?
- Group Insurance
- Company Paid Groups
- Affinity Groups
- Self-Insured Group
- Self-Employed Members
Member’s enrollment
- What is Enrollment?
- How is enrollment carried out?
- Output of enrollment process
- Enrollment: Overall Picture
Member’s and Dependent’s eligibility
- Eligibility
- Eligibility Process
- How a member should approach right provider?
- Eligibility Data Transfer
- Eligible Dependents
Member Services
- Means of services
- Services provided by the insurer
- Premium Collection
- Member Group Maintenance
- What are Groups?
- Groups Formation
- Groups Maintenance
- Disability Benefits
- Member’s concern
Sales
- Unit Objectives
- Introduction
- Brokers
- Calculation for Brokers
- Quote Creation
- What is a quote?
- The Process Of Quote Creation
- Actuaries
- Underwriters
- Insurance Payer’s Sales Department
- External Agents that deal with Sales Department of Insurance Payers
Provider
- Provider types
- Provider Participation
- Provider Contract
- Provider Contract Process
- Credentialing Criteria
- Verification of Provider Credentialing Information
- Types of Contracts
- Provider Reimbursement
- Provider Referral
- Referrals processing
- Referral types
- Provider Network
- Quality Provider Networks
- Network Adequacy
- Rental networks
- Network Hospital Standards
- Provider maintenance
- some common information of Providers
- Unit Objectives
- Introduction
- Indemnity Plans
- Managed Care Plans
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Point Of Service (POS)
- Exclusive Provider Organization (EPO)
- Which plan is the best?
- Other Plans
- Vision Plans
- Dental Plans
- Pharmacy Plans
- Medicare Plans
- Medigap
- Medicaid
- Long Term Care
- Disability Income Insurance
- Catastrophic Coverage Plans
- Individual Insurance and Group Insurance
- Laws and Legislations
- Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA)
- Health Insurance Portability and Accountability Act (HIPAA)
Claims
- Claim generation and submission to Providers
- Claims Intake Process
- Claims Intake : Diagrammatic
- Claim Adjudication Process
- Claim Preparation and determining eligibility
- Determine payment
- Update Claim
- Claim adjudication outputs
- Claim Payments
- Provider Payments
- Member Re-imbursement
- Member Re-imbursement
- Refund Adjustment
- Minus Debit Adjustment
- Minus Debit Adjustment
- Minus Debit Adjustment
- Stop Adjustment
- Government reporting
- Explanation of Benefits (EOB)
- Accumulators
- What are Accumulators?
- Function/Purpose of Accumulators
- What is accumulated?
- Types of Accumulator
- Overall Claims system diagram
External Agents
- Unit Objectives
- Introduction
- Government Agencies
- Centers for Medicare & Medicaid Services (CMS)
- DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHSS)
- Centers for Disease Control and Prevention (CDC)
- Agency for Health Care Research and Quality (AHRQ)
- National Information Center on Health Services Research and Health Care Technology (NICHSR)
- Health Resources and Services Administration (HRSA)
- Exercise
- Government Acts and Regulations
- HIPAA
- ELECTRONIC HEALTH TRANSACTIONS STANDARDS
- CORBA
- Clearing Houses
- Benefits Of A Clearinghouse
- Clearinghouse versus Direct Filing
- Clearinghouse Income
- Exercise
- Third Party Administrators
- Specialized Adjudication Engines/Companies
- General Agents
- Accreditation Agencies
- The Accreditation Process
- Drug Manufacturers
Summary
- Unit Objectives
- Workflow
- The Beginning: Member wants to purchase insurance
- Getting a provider
- An Enrolled member wants to seek medical services.
- Member has filed a claim
- Effect of external agencies
Appendices
- Total E-Business Services Forecast for Healthcare
- The world Healthcare market and Healthcare IT spending
- The Cash Flux of the US Healthcare Industry
- Sample Quote Sheet
- Exercise
- Review Questions
- References
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What my Client's Say?
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It was a great course over my expectations. I am eager to have another course wıth you as soon as possıble ~ R. Kamand
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All in all, it was a very constructive and one in a lifetime experience. I'm so glad that I was part of it.~ T. Engin
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It was the best decision I had ever made in my life. Although it was expensive for me, but I don't regret even for one second. ~ Maruti Malla
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Thank you for this great course. I learned a lot of things, I met very nice people and I am happy that I had these 6 crazy weeks with you.".~ Najmul Shar A Baig
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Very nice and friendly tutor and staff. The course was very fruitful, particularly the input sessions during the first half of it.~ Radha Nandyala
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It was such great experience, though it was really intensive, it was worth doing it! Cant thank enough all team effort esp Mohan! .~ Rohan Kumar
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The course was really good because it was a practical course.~ M.Radha patel
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I liked this experience. Good tutor and nice mates. I will always remember it. ~ Jitu Bavaria
