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- The 2014 Big Picture on Cyber Security
- AFCEA Answers
- Ask the CIO
- Building the Hybrid Cloud
- Connected Government: How to Build and Procure Network Services for the Future
- Continuing Diagnostics and Mitigation: Discussion of Progress and Next Steps
- Federal Executive Forum
- Federal Tech Talk
- The Intersection: Where Technology Meets Transformation
- Maximizing ROI Through Data Center Consolidation
- Moving to the Cloud. What's the best approach for me
- Navigating Tough Choices in Government Cloud Computing
- The New Generation of Database
- Satellite Communications: Acquiring SATCOM in Tight Times
- Targeting Advanced Threats: Proven Methods from Detection through Remediation
- Transformative Technology: Desktop Virtualization in Government
- The Truth About IT Opex and Software Defined Networking
- Value of Health IT
Shows & Panels
The healthcare claims process
Wednesday - 9/4/2013, 12:16am EDT
We speak with Tom Romeo, the President of MAXIMUS Federal Services.
The interview starts by setting the stage.
There have been many publicized reports of the backlog of claims for The Department of Veteran's Affairs.
There are reports that there is backlog of 773,000 claims, with 480,000 over 125 days.
Tom Romeo points out whenever a claim gets rejected, a complex appeal process can be triggered.
The appeals process is detailed.
Some systems are designed to handle a normal flow of appeals in a timely manner.
When this process sees a spike, some systems freeze.
A properly designed appeals processing system should take into account application variations due to a bad economy, budget constraints, and political issues.
When it comes to a dispute, MAXIMUS Federal has put together over 500 subject matter experts in order to sift through the validity of each claim.
Included are nurses, physicians, attorneys, as well as medical directors and pharmaceutical specialists.
If improved outcomes and reduced costs is the goal of the current administration, an effective appeals process must be able to render an impartial decision.