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Medical Insurance Claims Process The the process of medical billing insurance claims starts with the healthcare provider treating a patient and then sending a bill of services offered to a health insurance company. The insurer then evaluates the claims based on several factors and determines which, if any services they will reimburse. There are some technical protocols and industry standards that must be met for the efficient and accurate delivery of insurance claims between the payer and medical practice. There is a software that the medical billing professionals use to record patient data, draft the claims, and submit them to the suitable party. Medical insurance claims can be delivered to the payer using either the manual or electronic method. Most healthcare providers and insurance companies prefer the electronic claim system. This the method is more accurate, more inexpensive and fast to process.
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Filing Electronic Claims There are some technologies that have been introduced into the system so as to expedite application processing and increase accuracy. These are the following.
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Software Some healthcare providers use software to feed information to the CMS-1500 and UB-04 documents electronically. The chances of having unreadable information is reduced by using the fill and print software. The software also may include certain tools that check for errors in the documents. Despite the fact that these tools decrease the instance of errors, they are not 100% accurate hence the medical biller should observe diligence when using the software. OCR (Medical Character Recognition) OCR equipment is used to scan official records, electronically isolate and record information provided in the different fields and auto-filling that information into other documents when needed. The OCR technology helps make hard copy claim processing more efficient, but human oversight is still needed to ensure accuracy. Advantages of Electronic Medical Bill Claims It is possible to integrate information between the hospital system and the insurer system. The time of insurance reimbursement is reduced. Uisng this system, you can save more electronic data for patients than when using manual records. It allows for customized patient medical and personal data that includes their medical history, tests, diagnosis, insurance policy and details of the insurer, and other relevant information. Fewer errors in application when using the electronic medical billing claim over the manual billing. There are numerous medical billing clearinghouses that use electronic means to file medical claims. Clearinghouses are a third party service that acts as a link between the health care provider and the insurer. What the clearinghouse does receive claims from the health care provider, remove any errors in them, and put it in the HIPAA and insurance standards format, and then send it to the appropriate parties. The the clearinghouse is necessary because the healthcare provider is required to send high-quality insurance claims each day to many different insurance companies. Each of these companies may have their own submission rules which the hospital may not be aware of and thus the reason why clearinghouses come in handy.