We used health claims data recorded between 2007 and 2018 in the Korean National Health Insurance Service (KNHIS) database. In South Korea, the health security system provides healthcare coverage to all citizens, which has two components: National Health Insurance (NHI) and Medical Aid. > ...
Most measurement tools for HIL and related constructs have been developed and used in the context of the USA health insurance system, primarily in Medicare, while there is a paucity of measurement tools for private health insurances and from other countries. Furthermore, there is a lack of conc...
Community rating refers to a method used by insurers to set premium rates based on demographic characteristics (gender and age), as opposed to rates based off health status or claims history (experience rating). An entitlement program is a government program that provides resources to those that ...
Lower health insurance claims management costs significantly by automating processes, and increase auto-claims adjudication rates using a business rules–driven workflow. IDC MarketScape named Oracle a Leader in RCM IDC positioned Oracle as a Leader in its 2022–2023 IDC MarketScape for U.S. RCM Pro...
Second, the fact that our study may be prone to biases and shortcomings of claims-based data studies. For instance, we did not have details of clinical information, diagnosis details, or use of over-the-counter medications that were not covered/collected by the insurance system, which makes ...
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Operational efficiency Lower health insurance claims management costs significantly by automating processes, and increase auto-claims adjudication rates using a business rules–driven workflow. IDC MarketScape named Oracle a Leader in RCM IDC positioned Oracle as a Leader in its 2022–2023 IDC MarketScap...
Logical Entities Entity Name SUBSTANCE TIMING CODE SUBSTANCE TYPE CODE SUBSTANCE VEHICLE CODE SUMMARY OF CLAIMS SUMMARY OF HR AND PAYROLL SUPPLY SUBTYPE SUPPLY TYPE CODE TAX TYPE TEST REFERENCE RANGE THERAPY ORDER TIMEZONE TIME DAY SNOWFLAKE TIME OF DAY TITLE CODE TRAINING TYPE TRANSUNION CREDIT ...
The OCHIN network of CHCOs serves an exceptionally large and diverse patient population, using a data structure that provides more longitudinal detail as compared to most existing pregnancy-research data resources (i.e., not relying only on inpatient data and/or health care claims). However, ...
The gray lines in the postencounter phase represent a process flow volume of less than 100%, reflecting claims that do not require each step in the process. For a full process map illustrating quantitative detail and other complexities, see the eFigure in the Supplement. DNFB indicates ...