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Outline what implications will occur when there are gaps between the hospital's process for Utilization Management, and what the Insurance Payer's process might be, related
Outline what implications will occur when there are gaps between the hospital's process for Utilization Management, and what the Insurance Payer's process might be, related to timing of scheduling/delivering care, the pre-approval of care, the of proper payment of care, and the process that happens if the payment appears to be denied, or less than the provider expected. Is this process a simple one? Does it call for improvement or administrative simplification?
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