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Medical Billing 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 the insurance company then assesses the claims based on some factors to determine what claims to cater for if there is any. There are several technical rules and work standards that must be fulfilled for insurance claims to be delivered conveniently and accurately between medical practitioner and the payer. Medical billing specialists typically use software to record patient data, prepare claims, and hand them to the right 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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Filing Electronic Claims Certain technologies have been incorporated into this system to speed up the claim processing and improve the accuracy. They include 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. By using the fill and print software any chances of unreadable information is eliminated. This the software may also include specific tools that can check for any errors in the document. While these tools reduce the errors in the reports, they are not completely accurate, therefore the medical biller should be diligent when filing out the forms using the 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. 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 insurance claims than when using manual billing. 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. 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 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.