Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process.

@article{Shesser2000ResultsOP,
  title={Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process.},
  author={Robert Shesser and Karie Holtermann and Jacqueline A M Smith and Jane Braun},
  journal={Annals of emergency medicine},
  year={2000},
  volume={36 3},
  pages={212-8}
}
STUDY OBJECTIVES We compare the results of a provider "self-adjudicating" outpatient emergency department claims using a "presenting symptom-based" system with the managed care organization (MCO) adjudicating the claims using a "final diagnosis-based" system. METHODS All outpatient visits from one MCO to an urban, university hospital between January 1, 1998, and February 28, 1999, were included. Each record was reviewed by 2 methods to determine whether the visit qualified for payment under… CONTINUE READING