Claims Processing: Could My Claims Be Returned by the Insurance Company? Why?
Claims can be returned for a variety of reasons. The most common cause for a rejected claim is missing or inaccurate information. For example, errors in patient data such as the date of birth, age, sex, address, or name will cause an immediate return. Then there is provider information and insurance identification numbers, which can […]
Claims Processing: What is Claims Adjudication?
This is a short summary of the claims adjudication process. For a comprehensive whitepaper outlining the entire process please complete the whitepaper download form below. After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company […]
Claims Processing: How to Avoid Claim Denials
The best healthcare practices know that managing claims and avoiding unnecessary claim denials is a crucial part of the business. Errors, oversights, and delays in processing can cause more than you might think. To have an immediate impact on your business make improvements in these three areas. All claims must be legible. Even claims printed […]
Claims Processing: Why Doctors Should Monitor Medical Claim Status
Most doctors have experienced some medical claims headaches at some point in time. The routine monitoring of patients’ medical claim status can help you prevent potential problems or claim denials before they occur. The likelihood that you will ever receive a payment drops significantly if your claim is denied once. You can save a lot […]
Claims Processing: How Claims Are Authenticated
Payment for medical services can be a complicated process due to the involvement of a third party (insurance) with interests of its own. You may already know what the process of submitting a medical claim is like, but what happens after the claim leaves your desk and is sent on to the insurer? Here, we’ll […]
Claims Processing: How to Write a Claim Letter
A health insurance claim letter is a letter a claimant writes to a health insurance company if the claimant’s doctor has not properly filed a medical claim. This letter typically seeks for a reimbursement to the patient after the patient has already paid their medical bill, per the agreement between the claimant and the insurer. […]
Claims Processing: How Claims Are Paid
The claims process starts when a service is rendered to a patient who has medical insurance. Once the service is provided, the patient may be responsible for some out of pocket expense, but the rest will be paid through insurance and will involve communication between the medical practice and the patient’s insurance provider. Here, we’ll […]
Claims Processing: Optometry vs. Ophthalmology
Trusting a doctor with eye care is an important health care decision. The type of eye doctor a patient uses is largely a matter of personal preference if the eyes are healthy and don’t require specialized medical or surgical treatment. There are two types of eye doctors: optometrists and ophthalmologists. Both perform routine eye exams […]
Claims Processing: Dental Claims vs. Medical Claims
There are some similarities between preparing dental claims and medical claims. For example, patient and insurance demographics and insurance information that must be provided to medical carriers are similar. However, there are some very significant differences between the two. While dental carriers typically require a procedure code. Medical carriers not only require procedure code(s) but […]
