Health Maintenance Organizations (HMOs), unlike preferred maintenance organizations (PPOs), require a great deal of labor to be performed by the providers staff.
Pre-approvals are a major
component of this labor for events such as specialist-based consultations from those that are in-network and out-of-network, letter generation, appointments, and even facility approvals for tests
such as those within the radiology domain. Some of this labor is handled electronically, such as the ANSI X12 270 standard that involves eligibility, coverage, or benefit inquiry. Others such as
letter writing and scheduling involve elements from within a Document Management platform or Practice Management Systems (PMS). Read Chapter 18 (file uploaded) and Health Insurance link:
https://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.htm -Number the document from 1 to 3 and answer the following: 1. What are the technical challenges of a medical practice that engages in
electronic transactions, document management, and scheduling but also uses analog forms? 2. How are the information technology (IT) needs for an HMO and a PPO different? 3. How can the IT needs for
an HMO and PPO be integrated, especially if there is not one overarching healthcare information systems (HIS) Application handling it all? Note: Do not write introduction & conclusion. Do not
plagiarize. You can research on the Internet or books/journals & you can add additional references.
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