BA Health Care Online Training

BA Health Care Online Training

BA Health Care Online Training
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

Drop your query

What my Client's Say?

 

  • Prabhu is an excellent instructor, very patient and thorough. I have tried another training class and EXPLORE IT far exceeds other trainers and their methods ~ Hassan Malik

  • An extremely helpful and informative course. Training materials were well organized and provided good case studies. Instructor was extremely professional and pleasant to learn from.~ Bhavani Sudarshnam

  • The training was clear and detailed. I like Parker's style of teaching as the recurrent training is a thorough review of the HR. Every opportunity for the student to ask questions was provided. ~ Yiting Chen

  • Jane Anderson conducted the class in a very professional manner. Examples were very relevant and I feel that I gained a lot from the updated materials this year.~ Somesh Taneja

  • Prem was a great instructor. Thanks Prem for making the training easy to understand. A lot of information was covered. He made the approach easy to follow.~ Komali Sambakula

  • She wants to make sure that her students walk away from her course with a good working knowledge. She is an excellent trainer and cares that all of her students learn the material.~ Kiran Jain

  • Krishna is very thorough and professional. He made the code very understandable. I was very impressed with his teaching methods and presentation of the regulations. EXPLORE IT is the best! ~ Rajesh Isukapalli

  • Mr. Chris Brown was very affirmative with the course, on time and fluent. This is my second recourse with him. I hope to take his course as long as I am shipping at my current job. ~ Awais Rahim