Medical billing claims processing




Claims Processing 


We should know what are steps involved in insurance claims processing to better understanding.

Every insurance have their own software to process the claims but the process somewhat simillar.

• Does the provider have a valid contract with insurance?

• Was the patient eligible for services?

• Was prior authorization obtained for the service (if applicable) and was the service


provided within the approved dates?

• Was the primary insurance billed prior to this insurance (If any)?

• Is it a duplicate claim?

If it fails one of these edits, then the claim will be rejected, or else it will moved to next step.

• Here claim will be process manually as well as software application and claim will paid or denied.

Medical insurance billing

1 comment:

Anonymous said...

Can anyone explain the next process.

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