Question

describe and provide examples of at least four core operational competencies of a typical managed care information system

Answer 1

The managed care information system comprises of all the data pertaining to patient and useful to peivide a quality care and reduce the expenses unnecessarily

Some of the core competencies of managed care information system are

• Payment of claims and management of premiums
  • eg.,When a patient is admitted for a medical illness,the information system analyses, interprets and verifies whether the claims is approved by the insurer   
• Provider enrollment
  • e.g.,This enables the providers to be enrolled in it.When a new p rivider joins the organization, after the enrollment with the organization, the providers details are automatically managed in the information system
• Benefit configuration
  • e.g.,The service rendered to a patient are charged through Claims.If a provider offers a care ,a payment happens and they are supposed to pay the organization on the basis of care ,this acts as a benefit to the patient
• Customer service
  • e.g., This forms the basis of care provided to the sick,it enables to identify the types of customer service needed for individualized patient.