Health Care Domain Training

Course Detail

The medical services industry is perhaps the quickest developing area in the US. Hero Technology Inc giving Medical services Area Preparing continuous ventures. In the beyond 15 years significant government orders and guidelines like HIPAA, NPI, ICD, HITECH and ACA have imbued significant speculations across all significant association types. Upper hand of the payers as far as clinical misfortune proportion is a consistent test. Information science, AI and preventive consideration is playing out a heavenly job in understanding those objectives. This course is tailor-made for the cutting edge business/quality expert who is prepared to dive into this holding field, supplement their range of abilities with substantial information through a riveting yet minimized series of classes, tasks and venture work.

Assignments rolling into Projects

  • Clearing House integration with Payer for 837p and 276 transactions includes X12, data mapping, companion and implementation guides
  • PAPI to NPI conversion using LUHN algorithm
  • Member website use case modeling
  • Enterprise imaging systems conversion of paper claims to electronic forms
  • Microsoft health vault integration with third party wellness services
  • Open EMR reverse engineering
  • Includes XML, SQL, WSDL, Data Mapping, use case, UML, supp specs, JAR, wire-frames

End of the course activities

  • Question bank from interviews walk through
  • Interview questions, demo of answers and open discussion
  • Mock interview sessions
  • Resume preparation and critic
  • One on one individual sessions with all class students

Course Syllabus

  1. Domain pillars
  2. Regulations, compliance and mandates
  3. HIPAA Law
  4. Terms and terminology
  5. Administrative and Clinical Functional division
  6. Managed Health concept

  1. Basic concepts and flow diagram
  2. Service types and benefit types
  3. Schedule of benefits, fulfillment
  4. Dive into analytics
  5. Benefit package and products
  6. Line of business
  7. Group and individual market
  8. QHP and MLR
  9. Public and Private Exchanges

  1. A look into basic HIPAA X12 transactions
  2. 270-271 , 837i/p/d , 276-277, 278-13, 278-11, 835, 834, 820, 275
  3. CMS-1500 and UB04 forms
  4. Crosswalks and gateway systems

  1. Building blocks of a X12 transaction
  2. Business analysis life-cycle between trading partner interactions
  3. Segments, elements and rule-sets
  4. Data mapping using the implementation guide (TR3 reports)
  5. Companion guides
  6. VCML and transport mechanisms

  1. Clearing houses as independent TPA
  2. M-1 and M-M (B2B) models
  3. Use Cases and companion guide integration

  1. Local and global code sets
  2. Diagnosis, procedure, health care status, remark, NDC, taxonomy LOINC codes
  3. ICD 9 – ICD 10 conversions
  4. General equivalence mapping

  1. E2E Payer system layouts
  2. Claims processing and adjudication steps including claim check rules
  3. Finance and revenue management
  4. Warehousing and audit process
  5. Fee schedule based vs. Capitation
  6. Facets documentation

  1. Overview of the programs
  2. Qualification criteria
  3. Medicare advantage and Medicare supplementary
  4. Medicare cross-over claims
  5. Coordination off benefits
  6. State Medicaid programs , MITA architecture

  1. Rx benefits
  2. Pharmacy Benefit managers
  3. Formulary and manufacturers
  4. E-prescription and integration with EMR systems
  5. NCPDP claims , encounter reporting

  1. Electronic health records
  2. Individual, payer based and provider based records
  3. ADTs and ORU transactions
  4. CCDA transactions
  5. Microsoft HealthVault platform and integration
  6. EMR systems and use cases
  7. HITECH bill and certified EHR
  8. National Health Information network

  1. Utilization Management
  2. Case and Disease management
  3. Care Management and alerts

  1. Cloud service usage
  2. Big Data
  3. AI and Machine Learning
  4. Blockchain

Course FAQs

Course Testimonials

Paul K

Hero Technology Inc is the best web based preparing organization I have gone over. After through research fortunately I picked Yes-M Frameworks to get preparing for BA and Medical services classes. Subsequent to preparing I was a lot of comrade and landed position in something like 3 months of finishing of preparing. Indeed M Frameworks is an extremely proficient organization. I would energetically prescribe YesM Frameworks to anybody looking for IT preparing in any field.

Diggavi

I did BA/QA Area Specialization Medical care course with Hero Technology Inc in august 2016. It was extraordinary growth opportunity, every one of the educators are exceptionally proficient and knowledgable. The tasks that they give will assists in understanding the subjects with welling. Hero Technology Inc has great HR group which help in continue planning and counterfeit meetings. I would definately suggest my companions who are intrigued for BA course.

Jaxon

I'm completely happy with BA/QA Area preparing, Hero Technology Inc preparing was careful, serious, speedy, project based. All educators were truly learned, Nandu truly accommodating, consistently answered immediately , consistently accessible for direction. In couple of weeks you can get to glean some significant experience, from essential to cutting edge subjects - use case to client story, from cascade approch to lithe procedure, I adored the JAD class and UML class. Vanketash is entirely learned teacher, never was baffled of any inquiry. Not to fail to remember consistently I see something like one BA/QA opening presented from Hero Technology Inc.

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