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Maintaining compliance ensures transparency, prevents fraud, and promotes proper reimbursement for healthcare organizations.
HEDIS measures cover various aspects of healthcare, including preventive services, chronic disease management, and patient experience, to assess and compare the performance of different organizations.
It encompasses proactive measures such as implementing safety protocols, conducting thorough risk assessments, and continuously monitoring and improving processes to prevent and manage risks effectively.
The process of verifying and evaluating the qualifications and competence of healthcare professionals.
Strategic planning and execution of promotional activities to raise awareness, attract patients, and communicate the value and benefits of healthcare products and services.
Evaluating and monitoring the utilization of medical services, such as hospital admissions, diagnostic tests, and treatments, to promote cost-effectiveness and quality patient care.
Administration and oversight of contractual agreements with various stakeholders such as healthcare providers, suppliers, and insurers.
By providing expert advice, guidance, and recommendations to healthcare organizations and professionals to improve patient care, operational efficiency, and strategic decisionmaking.
It Involves a comprehensive evaluation of organizational processes, workflows, and performance metrics to identify areas for improvement and optimize operational efficiency.
It involves the utilization of networks of healthcare providers, preauthorization of services, and care coordination to ensure efficient and effective healthcare delivery.
These services encompass data integration, data warehousing, data analytics, and data reporting to facilitate evidence-based practices and inform strategic initiatives in healthcare organizations.
Providing specialized administrative and management support to physicians and medical groups within the purview of managed care.
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