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Medical Insurance Claims Process Medical billing insurance process claim begins with a health care provider treating a patient and then sending the bill of services provided to the health insurance firm. The insurer then evaluates the claim based on several factors, determining which services they will reimburse. There are some technical protocols and industry principles that must be met for the insurance claims to be delivered accurately and conveniently between the medical provider and the payer. Medical billing specialists use some software to take the patient data, prepare insurance claims, and hand them over to the appropriate party. There are two methods used to deliver insurance claims to the payer: manual and electronic. The electronic claims system is the one preferred by the majority of health insurance companies and healthcare providers. This system is faster, cheaper, and more accurate.
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Electronic Claims Filing There are some technologies that have been introduced into the system so as to expedite application processing and increase accuracy. They include 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. While these devices decrease the occurrence of errors; they are not 100 percent accurate and hence the need for the medical biller to remain diligent when filling out forms using this software. The 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 assists in making the hardcopy claim processing much more efficient, but it is important to have human oversight to ensure accuracy. Advantages of using Electronic Medical Claims Service Integration of the insurance company and hospital system is possible. The time of insurance reimbursement is minimized. The the system allows saving of more patient related electronic data than when using the 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. Several medical billing clearinghouses use electronic methods in filing the medical claims. Clearinghouses are a third-party operation that acts as a middleman between the hospital and the insurance carriers. The work of the clearinghouses is to receive claims from the hospital, edit them to remove any errors, format them correctly, and finally send them to the appropriate party. 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 the insurance companies have their submission regulations and the medical facility may not know of this hence the need for clearinghouses.