How Medical Claims Processing Works
Medical billing entails a process whereby one party, the healthcare provider, forwards documents to the next party, the insurance company, seeking payment for the medical services offered to one of their clients. The process is carried out in all insurance companies, whether public or private. The patient’s diagnosis and treatment information is included in the medical coding.
Many people are now able to gain access to an affordable health care throughout the U.S. They have revolutionized the way healthcare works.
For decades, the process of submitting these medical documents was done on raw paper. It involved faxing of copies of documents to and fro through the entire process. Before a resolution was reached by both parties, it took a long time.
Technology has played a crucial role in making the medical billing process electrical. Medical claims processing software have replaced the previous manual paperwork. EDI Billing has improved the speed of filing these claims and has improved the communication channels.
The health information system has allowed hospitals to manage a huge number of claims at once. It has allowed room for instant feedback and real-time update of data. People who identified the opportunities that come with these changes have managed to reap huge rewards.
Software and technology companies realized the potential of medical claims processing and have done their utmost best to provide hospitals and insurance companies with the best solution. The communication channels between the insurance company and the hospitals have also been improved by the claim processing software.
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These changes have also brought about the birth of medical billing clearinghouse. These clearinghouses act as an intermediary whereas they help the hospital to submit the claim to the insurance company. Clearinghouses also conduct claim scrubbing which is checking for errors related to the claim. They also double check to ensure that the hospital’s claim is compatible with the health insurance’s claims processing software.
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The process of medical billing may take a long time to complete and it is complicated even further if the payer and the provider are enrolled in two different clearing houses. This means that the claim will be forwarded from one clearinghouse to the next and the process might go to and fro. The process means that there are higher chances of the claim getting lost and falling into the wrong hands.
It is always better to ask your claims clearinghouse where the claim will go after it leaves their office so as to avoid any unnecessary delays or loss of information and data.