Patient Registration: Demographic information related to the patients along with insurance and contact details are gathered from the patient.
Patient Visit: Patients receive medical services. Medical records of the patients are kept in detail including diagnosis and the procedures performed in relation to that diagnosis.
Coding: Codes are given by medical coders to medical diagnosis, procedures as well as medical services provided to a particular individual. These codes are used to bill insurance companies for reimbursement.
Claim Preparation: A claim is prepared giving details of the patient, the insurance cover, and the corresponding services provided that have been assigned codes.
Claim Submission: That claim is then submitted electronically to the insurance company of the patient.
Claim Adjudication: The claim submitted is received by the claim of the insurance company and it is examined for sufficiency and accuracy. Once the insurance company and provider’s contracted coverage is received, that amount will be paid by the provider.
Payment or Denial: In the event that the claim is accepted for payment, the next step is the sending to the medical provider the claim payment. If a claim is denied, it means a medical provider will have to re-submit it or appeal the claim.
Patient Billing: Before being covered the insurance companies, patients will encounter payment on co-payments, amounts in their deductible, and any other amount not covered by an insurance policy. Patients are sent bills, and they will be rest assured that an attempt to recover the outstanding amount is made.