Paid claims analysis: a power tool for medical management.
The author describes a method of tracking medical services ordered by a plan's (or a capitated group's) doctors and analyzing the associated paid claims in order to identify physicians who are practicing inefficiently. It also identifies plan members who are overlooking the referral rules of their HMO plan.
Reich
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Harvard Pilgrim Health Care, Quincy, MA, USA.
D003626:Data Display; D016208:Databases, Factual; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D007345:Insurance Claim Review; D008485:Medical Audit / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States