The method behind every stage.
The Boaz Model structures the engagement. The Reimbursement Fidelity System is the analytical method applied inside it. It traces a case or a contract through the evidence at each link: clinical economics, contract terms, claims, remittances, denial and appeal records, payment received and, finally, access.
Each stage of the Boaz Model draws on the segment of this chain relevant to that engagement. The full trace is not run every time.
Four links, four questions.
What the care actually costs to deliver, checked against what the payer contract says it will pay.
What was billed and what was paid. This is the point where contract terms either hold or drift.
Read as evidence of where payment departs from the contract and whether the departure was contested.
What reached the organization, and whether that amount sustains the service or the program in question.
Which link is the one you suspect?
Naming the link you already doubt shortens the first review considerably. Naming none is also a fine place to start.
Discuss a decision