CLAIMS PROCESSING

Medical claim processing is not as simple as a walk in the park. When Providers render medical treatment to patients, they get paid by sending out bills to Insurance companies covering the medical services. It involves a lot of steps.

Firstly, claims are prepared by assigning specific ICD (used for diagnoses) and CPT (used for treatment) codes to the medical services provided. These claims contain important information like patient demographics and plan coverage details. HIPAA is one such standard that ensures high-level security during patient data transmission. Processed claims are filed electronically to expedite the process and improve efficiency. Then, the claims are submitted to the Payers. The insurance companies evaluate each claim and reimburse it accordingly.

Claim Processing is a complex task that can be carried out only by skilled professionals who have great attention to detail, immense training in the new coding techniques, good communication skills, and knowledge on current healthcare trends. To be qualified by the Payers, claims have to go through many technical protocols and pass industry standards.