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首页> 美国政府科技报告 >Defense Health Care: Claims Processing Improvements Are Under Way but Further Enhancements Are Needed
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Defense Health Care: Claims Processing Improvements Are Under Way but Further Enhancements Are Needed

机译：国防医疗保健：索赔处理改进正在进行中，但需要进一步改进

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Concerns about claims processing timeliness and accuracy have plagued the military health care system since the advent of TRICARE, DODs managed care program. During the 1-year period ending June 1998, the contractors we reviewed processed approximately 19 million claims worth over $1.7 billion. Health care providers and beneficiaries have frequently complained that claims were being processed too slowly and that many errors were occurring. While DOD contractors have acknowledged that they experienced problems processing claims in a timely manner during the start-up phase of health care delivery, they contend that they are now meeting standards. In response to your request, we evaluated the timeliness and accuracy of claims processing. We also evaluated the effectiveness of DOD's use of a claim editing software package it requires contractors to use.

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