Friday, October 19, 2012

Health Maintenance Organizations (HMOs)

According to the resource posted on, Department of Licensing and Regualtory Affairs:
Health Maintenance Organizations (HMOs) provide preventive care and other services that are basic to good health. It is a health care system that joins together the financing and delivery of health care services to covered individuals by arrangement with selected providers who furnish a broad set of health care services
The HMO resource includes the following topics:
  • The HMO Difference, Advantages & Disadvantages
  • Primary Care Physician
  • HMO Provider Network, HMO Service Area, HMO Eligibility
  • Individuals Open Enrollment FOR HMOs
  • HMO Coverage for Pre-Existing Conditions
  • HMO Underwriting, Basic Health Services and Mandatory Coverage
  • Services Not Covered By HMOs
  • Emergency Services From an HMO
  • HMO Prescription Drug Coverage
  • HMO Deductibles, Copayments And Coinsurance
  • HMO Claim Handling
  • HMO Coverage for Family Members and Coordination of Benefits
  • HMO Complaints and Grievances
  • Medicaid HMO Clean Claims
To view the full resource, please go to the following link: Health Maintenance Organizations (HMOs)

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

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