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 […]
Medical Claims Processing: Tips for Appealing a Denied Medical Claim
Medical claims may be denied for a variety of reasons. Fortunately, there are some ways for patients to appeal a denied claim within six months of the healthcare service. Follow these tips and you will have better success recovering denied benefits from your insurance company. First, it’s important to understand exactly why the claim […]
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 […]
Medical Claims Processing: What Does a Medical Claims Processor Do?
Caring for the health of your patients is the most important part of your business. That is why millions in the healthcare industry rely on specialized professionals, like Apex EDI, to manage the complex interactions between healthcare providers and medical insurance companies. Allowing others to handle this responsibility for you lets you focus your attention […]
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 […]
Medical Claims Processing: Medical Claims Processing Laws
Between dealing with physician, patient, and insurance data, staff in your billing department will be handling a lot of sensitive information. This is why it’s important for everyone in your billing department to understand the laws protecting that information and what they and the practice are responsible for, when it comes to the laws surrounding […]
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 […]
