Learning The “Secrets” of Healthcare

Processing Medical Insurance Claims

Since the cost of medical expenses are getting to be expensive, it will be difficult to be sick and hospitalized, especially if you don’t have much financial resources, and that’s why most people are into health insurance in order to reduce the impact of medical expenses, and since payment coverage of health insurance is affordable since you pay premiums either on a monthly or annual basis, more and more are subscribing in it.

If the time comes when the health insurance subscriber is in need of using her health insurance benefits for medical treatment, the first thing to do is for her to go to the healthcare provider’s office or clinic and hand over her insurance card and in exchange, she receives a demographic form for her to fill up with required data, such as: patient’s name, date of birth, address, Social Security number or driver’s license number, the name of the policyholder, and any additional information about the policyholder, and a government-issued photo ID.

After finishing the paperwork, the patient now sees a designated physician who will provide the consultation and treatment service, as well as other medical procedures that are needed to treat the patient, after which all these services are going to be recorded by the coder and determine the charge cost of each service by the medical biller, such that the summary of these charges is called the medical bill or also referred to as the medical insurance claim.
Smart Ideas: Claims Revisited

As soon as the coder hands over the bill of the patient to the medical biller, the information on the bill is entered as information by the medical biller into an appropriate claim form through a software billing application, in which the claim is sent to the health insurance company of the patient and to a clearinghouse, which is a third-party company that operates on checking and validating the document from errors found in the claim.
The Key Elements of Great Software

If no clearinghouse is hired to validate the claims, when the health insurance company receives the medical insurance claim, there are three possible actions that may occur: accept all expenditures and pay the bill or deny the claim on account of a billing error, to which the bill is returned to the healthcare provider to be corrected or reject the claim on account that the services rendered are not covered within the health plan of the patient. This just shows the value of a clearinghouse, where errors are immediately addressed including which services are covered under the health insurance, such that the healthcare provider will be sending over a corrected medical claim to the health insurance company and in this process, there is a likely possibility that the previous options, such as denying the claim due to an error and rejection of the claim on account that the services are not covered by the health plan, may be eliminated.