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Process Group
Claims Management
Objective
Provide timely status of submitted claims.
Input
- Claim identifier
- Beneficiary identifier
- Provider identifier
- Encounter date
Output
- Time-based claim status
- Claim status ( e.g., not received, In process, partially approved, approved, rejected, requires more information, In medical review)
Task Set
Measurable Outcomes
- Time-based claim status
- Payment amount approved for claim
- Explanation of Benefits