Managed Care Software

Written by Kimberly Clark
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Managed care is a term commonly used to describe a healthcare system designed to control the steady rise in healthcare costs. Typically managed care refers to a set of pre-arranged agreements that exist between a healthcare plan, a set of providers, and the insurance company. Examples of healthcare plans are health maintenance organizations (HMO) and preferred provider organizations (PPO), whereas providers consist of doctors, dentists, hospital networks and rehabilitation specialists.

The primary goal of the managed care plan is to get all its members to work together to provide the best possible care in the most cost efficient manner. To coordinate the efforts of all the various participants in the managed care system, many plan administrators use managed care software to track their healthcare activities. In addition to ensuring that only quality, cost-controlled care is provided, plan administrators have to make sure all their providers are properly compensated.

Benefits of Managed Care Software

The use of managed care software can significantly reduce the plan's administrative and operating costs. By streamlining its work processes, the program can perform more tasks with fewer staff members. The software also gives the plan administrators a better way of maintaining their patient records and contract data.

Also incorporated in a good managed care software package is the ability to prepare and submit healthcare claims. The software should ensure that the claims adhere to all the latest government regulations directed at the healthcare industry. Additionally, the system may have provisions in it that allow for patient enrollment, benefit verification, specialist referrals, and procedure authorization--it really depends on your needs whether the extra bells and whistles are worth it.


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