Utilization Management Practices

Question

Quality Improvement and Risk Management

Directions

Find out what utilization management practices your health insurance company follows. This information may be available in your insurance benefits booklet or on your health plan’s website. If you do not have health insurance, go to the website of any major health insurance company and list the practices this company follows to control costs and to ensure the provision of medically necessary services. Provide a summary of your learning.

Criteria

1. A health insurance company has been identified.

2. Cost control have been presented.

3. An informative summary is included.

4. APA guidelines

Question

The specifications call for a shaft to be 1.000 inch in diameter. The acceptable tolerances are +/- 0.005 inches. By doing a process study, you have determined that the average output of diameter is 1.002 and the standard deviation is 0.002. What is the probability that a shaft taken at random from the process will need to be reworked (is too large) or will need to be scrapped (is too small)? What then is the probability that a shaft will be acceptable? Assume that the diameter of the shaft is a random variable that is Normally distributed.