|
Transparency in clearances of
insurance claims |
The
aMedLineNET software can enable the
insurance organization to conduct automated medical audit, that is
monitoring of compatibility between care services and ordered
examinations, prescriptions, etc.
Given the multitude and variety of statistical reports that can be
issued from the system, the insurance institution may, at any time,
conduct automated but thorough checks to a large amount of data like,
i.e.:
- Whether active ingredients of prescribed drugs are compatible with
diagnosis.
The distribution of referrals from one doctor to other colleagues in
the network
- The necessity of referral of a patient to a specialist doctor.
- The necessity of hospitalization
- The compatibility between medical examinations ordered and the
diagnosis of the doctor
|
