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.

There is a software that the medical billing professionals use to record patient data, draft the claims, and submit them to the suitable party.

There are two methods used to deliver insurance claims to the payer: manual and electronic. Majority of insurance firms and healthcare providers prefer the use of the electronic request system. The electronic claims system is more accurate, faster, and cheaper to process.
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Filing Electronic Claims
To quicken the claims process and enhance efficiency, certain technologies have been introduced in the system. These are the following.
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Medical Claim Software
Some healthcare providers use software to feed information to the CMS-1500 and UB-04 documents electronically. The fill and print software prevents the possibility for unreadable information. This the software may also include specific tools that can check for any errors in the document. 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.

OCR (Medical Character Recognition)

The Medical Character Recognition scans official documents, isolates and records information electronically in the varying fields, and transfers that data into other documents when necessary. 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 Electronic Medical Bill Claims
It allows the integration between hospital system and insurance company system.

The time of insurance reimbursement is reduced.

The the system allows saving of more patient related electronic data than when using the manual records.

Customized patient personal and medical data: location, insurance policy and insurance company details, medical history, tests, diagnosis, and other important information.

fewer errors in insurance claims than when using manual billing.

There are numerous medical billing clearinghouses that use electronic means to file 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 clearinghouses play an important role because hospitals have to send high-quality insurance claims each day to different insurance providers. Each of the insurance companies have their submission regulations and the medical facility may not know of this hence the need for clearinghouses.