Study: My Understanding of Processing

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How Medical Insurance Claims Are Processed

Because the cost of medical expenses is getting more and more expensive each year, people are depending on health insurance to help them pay partially the cost of the medical expenses, which are helpful in their financial and health conditions, and which prompts them to subscribe in health insurance because of the affordable terms, which is paying the premiums in either monthly or annually.

When a health insurance subscriber wants to make use of her insurance benefits for medical treatment, hereby are the procedures which she will have to observe: the subscriber hands over her insurance card and fills out a demographic form at the healthcare provider’s office or clinic, and the demographic form requires the following data: 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, if the policyholder is someone other than the subscriber/patient; also, the subscriber or patient presents a government-issued photo ID.

Once the paperwork is completed, the patient proceeds for consultation and treatment to a designated physician, such that whatever else are serviced to the patient will all be reflected as chargeable costs which will be recorded by a medical biller and coder of the healthcare service provider, to which this recorded document will serve as the bill or medical insurance claim.
A Simple Plan For Investigating Claims

The medical biller enters the information into the appropriate claim form through a billing software, in which the claim is sent to the payer, which is the health insurance company, and to a clearinghouse, which is a third-party company whose function is to check any errors documented in the claim.
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Without a clearinghouse, the health insurance company of the patient may possibly act on these possibilities, as soon as it receives the medical claim: 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 is where the clearinghouse is of valuable use to help correct errors and check the health plan coverage of the patient, such that when the clearinghouse sends over their validation on the medical claim to the healthcare provider, the medical biller and coder will use the validation as basis to reformat a new medical claim, which will be sent again to the health insurance company and, in this manner, there’s a likely chance that the health insurance company will eliminate its previous options, which are denying the claim due to an error and rejection of the claim on account that the services are not covered by the health plan.