Clinical staff will work around a process for claim rejection analysis that obstructs care, and they will be right to. The data supporting this area of health and pharmaceutical services is usually present but rarely assembled into a decision. The professional literature on this aspect of health and pharmaceutical services converges on a small set of controls that reliably work. Participants finish able to explain claim rejection analysis to a non-specialist audience without losing precision. It is appropriate for those preparing to take on wider responsibility for the wider health and pharmaceutical services agenda. Participants test their assumptions about the health and pharmaceutical services discipline against scenarios designed to break weak ones. The programme is built to be used, and every section of claim rejection analysis it covers ends in something applicable. What blocks progress on this aspect of health and pharmaceutical services is usually unclear ownership rather than unclear intent. The programme ends where implementation begins, with the health and pharmaceutical services capability broken into steps someone can start on Monday.
Expected Learning Outcomes
✓
Audit claim rejection analysis in practice, not only in policy.
✓
Align claim rejection analysis with the wider objectives of the clinical service rather than optimising it in isolation.
✓
Control cost per episode within claim rejection analysis without shifting risk to patients.
✓
Plan continuity of claim rejection analysis during surge, outbreak and emergency.
✓
Assess and control infection risk associated with claim rejection analysis.
✓
Translate policy on claim rejection analysis into procedures that hold up under day-to-day pressure.
✓
Distinguish the parts of claim rejection analysis that must be standardised from those that require judgement.
