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Medical Claims: What Does the Medical Claims Process Look Like?

The medical claims process begins when the patient goes to the healthcare provider for any service, from refilling a prescription to major surgery. The patient is responsible for paying the insurance deductible after the visit and providing insurance information to the healthcare provider.

Health insurance claim form with glasses

Typically, front office staff begin the claims process with a pre-registration form. Information such as patient name, birth date, and insurance policy number is gathered. Keeping current medical records helps expedite the billing and patient check in process. It can also eliminate errors that may occur. For example, if the patient forgets to bring insurance information with them.

Once the patient provides insurance information, the office must confirm the medical services that are covered under the patient’s insurance policy and what medical conditions the insurance provider requires in order to justify financial payment.

When the patient receives service, it is important for the provider to record all medical services received. To bill the insurance company, each service must be coded accurately. The bill must also be compliant with legal requirements set forth in the Health Insurance Portability and Accountability Act (HIPAA).

It’s imperative to confirm that fees are charged accurately and that every code submitted is billable before it is sent to the insurance company. This insurance medical claim provides the payer with important information about the diagnosis, procedures, and the charges. An accurate insurance claim ensures that you are reimbursed in a timely manner.  

Apex EDI acts as a clearinghouse and liaison between healthcare providers and insurers. We can help format claims and submit the medical claim to the insurance company. Accurate, timely claims help you get paid faster. Interested in our help? Contact us, at Apex EDI, to watch a free demonstration of our medical claims software today.

Posted in: Medical Claims

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