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Medical Claims Processing: How Are Medical Claims Processed?

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Once medical services have been administered to a patient, payment needs to be requested from insurance through appropriate channels. These requests for payment are known as medical claims, and to the lay person, filing them may seem rather complicated. We’re hoping to demystify this process by breaking down the way medical claims are filed and paid.

Each service rendered to a patient has a designated code so that the payer will be able to reference them against codes and services the patient is eligible for. These codes along with insurance and patient information make up the bill that is sent on to a clearinghouse on its way to the patient’s insurance provider. Medical bills are often processed and submitted through online channels because it saves time and money, but hard copies are still available and occasionally used for this process.

This is where Apex EDI comes in. Forms are sent through clearinghouses like Apex EDI before being sent on to the insurance company so they can be scanned for errors and reformatted to comply with HIPAA and insurance company standards. Clearinghouses like ours are necessary because each insurance company has different standards, and doctors offices are responsible for submitting high volumes of claims to different insurers on a daily basis. Without a clearinghouse, the strain on the billing department of the office would be astronomical.

The doctor’s office chooses which clearinghouse it works with, and it’s important to select one that works with the insurance companies you work with, can work with the software you have available, and is reliable. Luckily, we at Apex EDI work with many different insurers as well as many different software programs. Visit our website or give us a quick call to see how we go above and beyond to serve all of your medical, dental, and vision claims needs. Choose Apex EDI to help you get your claims filed faster, get paid faster, and take the stress out of the claims filing process!

Posted in: Medical Claims Processing

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