Preview

MEDLIMIT Human Service Case Study

Satisfactory Essays
Open Document
Open Document
57 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
MEDLIMIT Human Service Case Study
There is my understanding, this is defect for sure in MEDLIMIT DUR service but I do not this should be a high priority defect. This is a very unlikely scenario where a member will have 1000+ claims. Just a background the Client Management ran testing for a member with 1000+ claims in the test carrier.

Thanks
Tabbi
Continue Reading
View Writing Issues

You May Also Find These Documents Helpful

  • Good Essays

    Koeher Vs Aetna Health Care Case Summary
    • 802 Words
    • 4 Pages

    Koeher Vs Aetna Health Care Case Summary

    In this case, authorization was provided for the services, although under the incorrect patient information. Considering that SelectCare was promptly notified of the mistake, and that had the correct patient information been given, authorization would have been provided for the medically necessary services for patient E.F., the purported lack of authorization does not support denial of this claim. Indeed, it was no more than a technical default that caused no prejudice to SelectCare. See Koehler v. Aetna Health Inc., 683 F.3d 182, 188 (5th Cir. 2012) (recognizing that a lack of preauthorization “does not prejudice [the insurer]’s ability to refuse coverage if it concludes that the services were not medically necessary”); Weaver v. Phoenix Home Life Mut. Ins. Co., 990 F.2d 154, 158-59 (4th Cir. 1993) (reversing plan administrator’s denial of coverage because its denial that “hospital confinement commencing 05/16/90 was not authorized” was conclusory and the medical necessity of the inpatient stay, not any authorization of it, was what determined coverage). Under these circumstances, Medical City is entitled to payment in full for its services in the amount of $74,404.44. Demand is made for payment of this…

    • 802 Words
    • 4 Pages
    Good Essays
    Read More
  • Good Essays

    Case Study: Dr Melissa Walker's Health And Human Services
    • 1267 Words
    • 6 Pages

    Case Study: Dr Melissa Walker's Health And Human Services

    This case is about Dr Melissa Walker, she is a top-level orthopaedic surgeon who has either studied or worked almost all of her life. While on holiday in Santa Fe she met the love of her life, Michael Langford. He worked for a publishing company as editor in chief. They got married within 6 months after they met.…

    • 1267 Words
    • 6 Pages
    Good Essays
    Read More
  • Good Essays

    Medi Budd Case Study Answers
    • 524 Words
    • 3 Pages

    Medi Budd Case Study Answers

    On a scale of 1-10 how likely are you to recommend this product to a friend?…

    • 524 Words
    • 3 Pages
    Good Essays
    Read More
  • Good Essays

    Severity-Adjusted Diagnosis-Related Group Case Study
    • 593 Words
    • 3 Pages

    Severity-Adjusted Diagnosis-Related Group Case Study

    and the claim will be sent back to the provider for correction and then resubmitted to Medicare.…

    • 593 Words
    • 3 Pages
    Good Essays
    Read More
  • Satisfactory Essays

    Larger Human Services Case Study
    • 301 Words
    • 2 Pages

    Larger Human Services Case Study

    1. Programs are often smaller pieces of a larger human services organization. How will the organization’s mission affect your program?…

    • 301 Words
    • 2 Pages
    Satisfactory Essays
    Read More
  • Satisfactory Essays

    Memo Human Services Case Study
    • 322 Words
    • 2 Pages

    Memo Human Services Case Study

    We are all familiar with the ruling of the Tarasoff v. Regent of the University…

    • 322 Words
    • 2 Pages
    Satisfactory Essays
    Read More
  • Satisfactory Essays

    Unit 5 Health And Social Care Case Study
    • 266 Words
    • 2 Pages

    Unit 5 Health And Social Care Case Study

    Ms Cole explained that Ms Coleman and Mr Cole were equally responsible for the incident happened between them. Ms Cole further explained that both Ms Coleman and Mr Cole are adults and they were aware about the restraining order and the conditions applicable as part of the order however they have breeched this which Ms Cole considered as inappropriate…

    • 266 Words
    • 2 Pages
    Satisfactory Essays
    Read More
  • Good Essays

    Michigan Department Of Health And Human Services Case Study
    • 243 Words
    • 1 Page

    Michigan Department Of Health And Human Services Case Study

    The Michigan Department of Health and Human Services is responsible for answering and addressing all matters of public health for the population of the Michigan. Michigan Department of Health and Human Services works to retain this goal through a mixture of primary prevention, preventing sicknesses before they occur, secondary prevention and reducing the burden of un-wellness once it's occurred. The goals of the responsibilities of Michigan Department of Health and Human Services needs constant attention through health intervention, local law enforcement authorities programs and effective communication and coordination with multiple levels of presidency (local, city, and federal). The Michigan Department of Health and Human Services conducts…

    • 243 Words
    • 1 Page
    Good Essays
    Read More
  • Satisfactory Essays

    Health Coverage Case Study
    • 443 Words
    • 2 Pages

    Health Coverage Case Study

    Both Medicare and Medicaid human health services reimbursements do not hundred percent guarantee their clients or members of their services. These health human services reimbursements attach every individual to a certain hospital to a specific doctor. In a case where a patient who is a member in the Medicare health service is in a need of referral to a specialist, a long process is required. In that case, the Medicare is not to help any more not unless the member changes the network providers. In such a case, if the need is agent, the member will be required to make many copayments for the member to have the referral for a specialist.…

    • 443 Words
    • 2 Pages
    Satisfactory Essays
    Read More
  • Satisfactory Essays

    Human Service Programs: Commonalities And Successes: Case Study
    • 590 Words
    • 3 Pages

    Human Service Programs: Commonalities And Successes: Case Study

    Quality and outcomes is when the trends from now a days are used to control the quality of care that a Human Service Organization puts out to their clients. The better quality of care the organization they provide the better outcomes for the clients there is.…

    • 590 Words
    • 3 Pages
    Satisfactory Essays
    Read More
  • Better Essays

    BSHS 305: Issues Facing Human Services Clients
    • 1253 Words
    • 6 Pages

    BSHS 305: Issues Facing Human Services Clients

    In society today, there are numerous issues facing human services clients. Homelessness, services having their funding cut, and the association of stigmatization that one might receive while accepting services are just a few issues. Many of those who face these issues may always face substance abuse issues or may be in domestic violence situations. Due to the additional factors, clients may not feel as though they deserve to receive help, and therefore may not seek out the needed help to get their life back on track.…

    • 1253 Words
    • 6 Pages
    Better Essays
    Read More
  • Powerful Essays

    M3.23 Health And Social Care
    • 3240 Words
    • 13 Pages

    M3.23 Health And Social Care

    • Two pieces of legislation relating to health, safety and welfare at work are identified…

    • 3240 Words
    • 13 Pages
    Powerful Essays
    Read More
  • Good Essays

    Unit 2 Health And Social Care Case Study
    • 892 Words
    • 4 Pages

    Unit 2 Health And Social Care Case Study

    1. We can define reminiscing as the process of reflecting upon and reliving past events good and bad. This bodes the question of whether or not reminiscing is helpful for elderly people. There was a time when carers and nurses were encouraged to stop elderly people from talking about their past, it was thought that this would damage their mental health and cause them to regress. On the contrary it actually aided care and strengthened care relationships.…

    • 892 Words
    • 4 Pages
    Good Essays
    Read More
  • Good Essays

    Current Trends in Human Services
    • 1053 Words
    • 5 Pages

    Current Trends in Human Services

    The current economic and political climate has had a profound affect on the human services fields and has impacted those served in a very real and direct way. The Affordable Healthcare Act (AHA) for example has created such a backlash in the political and economic arenas that it has even caused the United States government to shut down due those who resist and fight its implementation and continues to be a heated debate. The relationship between economic and political events to the current trends in the human services field is becoming more and more intertwined as it geared toward providing services and meeting the growing needs of people everywhere, but with the human services funding deficits and cutbacks and with the political constraints causing complications, these needs are being threatened. Economic problems such as the recession and cuts in government spending and political problems such as the fight against the AHA have caused a lot of direct cuts to the human services programs and are not allowing the clients to be treated properly and for some clients there is no treatment at all. The economic and political events of today rule the trends of today’s society, by not possessing readily available services for those in need.…

    • 1053 Words
    • 5 Pages
    Good Essays
    Read More
  • Better Essays

    Software for Human Services
    • 1121 Words
    • 4 Pages

    Software for Human Services

    Southern Nevada Adult Mental Health Services is an organization that services the mental health population. This population has continued to grow, and because of the increased turnaround in clients served the company had to invest in multiple software products. Electronic Health Record or (EHR) is one of the software programs that are used by Southern Nevada Adult Mental Health Services. This software is designed to be shared with several different health care providers or settings. The Electronic Health Record software is an electronic collection of systematic health information about a certain population or client.…

    • 1121 Words
    • 4 Pages
    Better Essays
    Read More

Related Topics