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For example, the following factors all increase the complexity of processing payments: the changing and increasing need for processing referrals and the implementation of internal and external systems to streamline their issuance; the increasing number of diagnosis and procedure codes; prior authorization for medically necessary services; heterogeneous credentialing requirements; differing payment rules between payers in one health care market; opaque and elusive payment rules; the lack of uniform billing and administrative denial and adjudication processes; and the "arms race" between physician organizations and insurers in creating infrastructure to deal with these phenomena
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These projections include all administrative costs, taxes, profits, and other nonbenefit expenses of private health plans. Administrative costs related to billing are just one component of these costs
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A more detailed methods discussion is included in the Appendix, which is available by clicking on the Appendix link in the box to the right of the article online
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