BA Health Care Online Training

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• 9 years ago
• Categories: BA Online Training & Placements on VelocityInfo
• Tags: ba health care certification program, ba health care jobs placements, ba health care online courses, ba health care online training, learn ba health care online, online ba health care classes

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