Steps for a Successful Medical Claim Process

Today, we have many insurance companies that offer medical insurance. This is an insurance policy where the policyholder gets compensated when he/she gets sick and hospitalized. The insurance covers the cost of minor illnesses to complex surgeries. The policyholder must pay certain amounts of money to the insurance company every year. They are known as the premiums. After one is hospitalized, he/she must follow a process so that the medical bills are paid by the insurance company. There are many cases of denied, rejected and returned which result in defaulting payment of the medical bills by the insurer. The following are steps on how to avoid claims getting returned. Learn more about Apex EDI, go here.

The first thing the insured should do is the patient check-in. Ones the insured attends the medical facility, he/she must fill a patient check-in form. This form should have details such as the name of the patient, age, gender, home place, the name of the insurer, the insurance number and the national identity number. One copy of the check-in form should be left in the hospital while the other should be retained by the insured. The insurance company must ask for this document before processing the compensation. Find out for further details right here

The second process is the insurance verification. The insurance policy may change without the insured being informed. The medical facility must communicate with the insurance company so as to verify that the information submitted by the insured is true. The insured is also supposed to give the correct information on the insurance policy.

The coding of the medical procedure is the nest thing. The doctors attending to the insured patient must write or print a document detailing all the medical procedures being done on the patient. They also need to keep updating the improvements and changes in medications. The insurance company needs this information to make a good assessment.

The submission of the claim is the next thing. Ones the claim has been successfully completed, the insurer must be issued with it for a successful claim. The insurer will countercheck the information to see if it is true. The insured should know the right procedure to make a claim from his/her insurance company since insurance companies have different procedures.

The last step is the posting process. Once the insurance companies approve the claim, it must post the compensation amount in the hospital’s bank account. The insured is then free after the whole amount is paid by the insurance company. This is the process that one should follow in order to avoid common medical billing mistakes. Take a look at this link for more information.

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