If You Think You Understand Software, Then This Might Change Your Mind

Medical Insurance Claims Process

The medical billing insurance claims process starts when the health care provider treats a patient and sends the bill of services offered to a health insurance company. The the insurance company then assesses the claims based on some factors to determine what claims to cater for if there is any. 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.

Medical insurance alleges that be provided to the payer using two methods: the manual and electronic means. Majority of insurance firms and healthcare providers prefer the use of the electronic request system. This the method is more accurate, more inexpensive and fast 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. The techniques 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. By using the fill and print software any chances of unreadable information is eliminated. 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.

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.

Minimizes the time of reimbursement of insurance.

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.

It lessens the number of errors as compared to the manual medical billing application.

There are numerous medical billing clearinghouses that use electronic means to file medical claims. Clearinghouses serve as a bridge between the insurance carrier and the hospital. The clearing houses receive claims from the hospital, remove any errors from them, put it in the recommended format, then submit it to the relevant parties.

The clearinghouse is quite important because the healthcare provider is required to submit insurance claims that are of high quality at various insurance companies each day. Each of the insurance companies have their submission regulations and the medical facility may not know of this hence the need for clearinghouses.