Health insurance claims is where payment is process from
your provider to your health insurance. This is why is so important to make verification
first, and assure that medical insurance is cover by the provider. Claims have
information such as: patient’s diagnoses, procedures, and charges. This is
called claim management.
A form called Health Insurance claim (CMS-1500) is what is use to process a claim. As
I explained on other post previously, gathering the proper information is very
important in order to process everything accordingly. Coding (diagnoses and procedures) which
will be explained at a later post needs to be properly filled. The majority of
the process now days are electronically; payments will automatically pre-fill
in the system once coding is typed in the system.
One of the things an administrative assistant will be doing
when creating a claim is verify, edit, and/or change the status of a claim. There
will be certain step to follow up when transmitting a claim. The last thing you
do once everything is confirmed is transmit the claim electronically. Supporting
data (other documentation needed) verification will be necessary at time,
depending on the diagnoses of the patient. You can print claims, reprint and
delete claims as well.
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