Paper Title
Comparative Investigation Between Two Investigating Methods Of Random And Non- Random In Namazi And Shahidfaghihi Hospitals Of Shiraz City – 2014-15

Introduction: Investigating the documents provided by hospitals that have contract with insurance companies for preventing from unnecessary usage of insurance services is one of the most important challenges between insurance company and the hospital. Each procedure change in investigating the documents could create its special sensitivity in the hospital authorities and random investigation was placed in health insurance organization agendum since 2015. This study aims to compare two methods of random and non-random investigation on quality, hour and number of experts. Working method: The current study is a retroactive analytical descriptive study. Its statistical population includes six-month invoices of Shiraz Namazi and Shahid Dr. Faghihi hospitals from 2014 and 2015 which are kept in health insurance organization. The study data were collected in special checklists and formulated in Excel tables and analyzed by SPSS 20 software. Findings:In examining the comparison between two investigating methods of random and non- random in Namazi and Shahid Faghihi hospitals, there is a significant difference between expertism hours and the number of performing experts. There is no significant difference between the modification percent in total requested wards, laboratory, visit, hoteling, medicine and consumables and angioplasty services. In Namazi hospital, the modification percent of non-random method commission and in Shahid Faghihi, the modification percent of Cholecystectomy surgery is more. Conclusion: Random method of investigating hospitalization documents of insurance companies causes reduction of working hours and the number of experts involved in documents and doesn’t have any specific impact on investigation quality especially in the rate of modifications, of course using random investigating methods in costly and purposive sections and services could cause rising of works pace and making the investigation smart. Keywords- Expertism Method, Random And Non- Random, Hospitalization Documents, Health Insurance