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Three general categories of coverage policy—medical policy, benefits administration policy, and administrative policy—are used in...

Three general categories of coverage policy—medical policy, benefits administration policy, and administrative policy—are used in conjunction with purchaser contracts to determine a health plan’s coverage of healthcare services and supplies. With respect to the characteristics of the three types of coverage policy, it is correct to say that a health plan’s

A.

medical policy evaluates clinical services against specific benefits language rather than against scientific evidence

B.

benefits administration policy determines whether a particular service is experimental or investigational

C.

benefits administration policy focuses on both clinical and nonclinical coverage issues

D.

administrative policy contains the guidelines to be followed when handling member and provider complaints and disputes

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