Health Insurance Claims Management Issues in Georgia

Abstract

In the insurance market, the study of the adjustment of the amount requested by the medical organization is vital to ensure the stability of the industry and customer satisfaction. The research aims to analyze the adjustment process in the insurance market and to study the factors affecting the effective management of losses. According to research, the cost of the work performed by the medical institution is adjusted according to three main criteria: reimbursement, deadlines and discount. During adjustment, the following problems are identified: failure to consider the terms of the contract, neglect of its clauses, provision of disorderly documentation, and demand for compensation in an unscrupulous manner. The largest share of adjustments comes from hospitals, followed by pharmaceutical companies, outpatient clinics, and finally dental clinics. Although human health is important for medical organizations and insurance companies, their main goal is to increase revenues and make the right distribution for future purposes. It is important that insurance companies and medical institutions integrate software to eliminate problems, which will reduce deadlines, the risk of providing unnecessary services and other factors that cause adjustments.