Guide to Medical Claims Processing


There are a lot of patients going to health care facilities every day. And one of the most important parts of a health care facility’s operation is its medical claims processing abilities.

Medical claims must be processed in a timely manner to ensure timely payments by insurance companies they are also to be submitted to the appropriate insurance companies for consideration.

Medical billers and encoders are employed by some facilities. Other facilities employ individuals who will handle both aspects of the claims process simultaneously. If you are both a medical biller and coder, then you will generally earn more than a medical biller or a coder does. This is because he is performing double duties and eliminating the need for the health care facility to hire two different people.

The diagnostic codes and procedure codes that apply to the patient’s visit is provided by the medical coder. A claim may be denied if these two codes do not match. Most likely, the insurance company would say that the treatment was not medically necessary. This is why it is so important for the medical codes to be precise.

The correct codes are obtained by a medical biller from a medical coder. He then uses the codes to fill to a claim form. Then the claim is submitted to the insurance company in the form of an electronic claim. It is important that the medical biller comply with the requirements of each insurance company.  Many companies have specific guidelines that must be followed. There could be a delay or denial of claims if the claim form is not filled out properly and according to the insurance company’s regulations. You may also watch and gather more ideas about medical billing at

Some health care facilities are now using medical billing software in medical claims processing. The software saves time and eliminated common mistakes. Medical billing software allows medical coders to look up diagnostic codes and procedure codes via the claims processing software rather than in a manual. Databases are also checked by the software to ensure that the diagnostic codes and procedure codes are matched. This eliminates the denial of claims based on discrepancies.

Today, medical claims processing is a job that can be done from home. A lot of people today have started their own home business in claims processing software. This is one way that stay at home moms can earn an extra income and remain at home with their children. Moms can have medical billing and coding training. Simply check out sites where you can receive training in making a medical coding career.


Medical Claims Processing Made Easy


How do you understand the process how medical claims processing works? If you can answer this question then this article will give you the real deal about what goes on when you do a medical claims.

This is advisable for those who would like to take a short cut in getting your medical claims easily and faster. Many experts in the field believed and would recommend considering moving away from submitting claims on paper. Most medical providers require electronic claims. HIPAA requires standardized electronic insurance transactions rather than paper since the year 2003. Not just it allows you to follow electronic transactions but it actually saves time and money. It has a faster turnaround time for eligibility and claims responses but also for getting reimbursed by the papers. When submitting claims on paper, on average an insurance payer can take approximately 30 business days to adjudicate your claim while when submitting electronically that same payer has 14 business days to adjudicate that same claim. Initially cutting down your time in half to adjudicate process and ultimately provide you reimbursements in half the time.

Many experts have recommended after numerous studies and analyses and took into account all factors included when submitting claims on paper the stamp, toner, envelope, staff, time, et cetera. On average they have learned that your practice spends approximately six and a half dollars per claim when submitting on paper. Your practice savings can be reduced to 50 to 90 percent per transaction.

If a patient needs to see a health care professional for a medical service the patient goes to a clinic, a rehab center, a laboratory, a surgical center, a hospital, et cetera. The patient undergoes a checkup and goes back home. The health care provider documents the encounter with the patient. The document that was made is sent to the medical records department to be coded. The coded records are then sent to the finance department to be billed. If there is no record of insurance the bill is sent to the patient but if the patient has insurance, the bill is sent to the insurance agency. The agency pays for the covered services. The portion of the bill that is not covered is billed or sent to the patient. The patient then pays the medical facility for the portion the patient is responsible for. This is the summary of how edi billing processing works.

The process takes by verifying patient eligibility, creating a claim, submitting the claim, tracking that claim and processing that claim. Learn more about medical billing at

It goes to show that medical claims processing is very easy indeed.

Medical Claims Processing – Billing Software

Stethoscope with financial statement, calculator, pen

Everyday numerous patients visit health care facilities all over the country. A significant element of their operation is the health care providers they decide to use. Some hire better technicians, nurses, and physicians. Thus, more patients frequent them. A lot of people don’t understand that the essential element of the operation of a health care facility is its medical claims processing capability.

So as to make sure insurance companies make timely payments, medical claims ought to be processed in a timely manner and submitted to the relevant insurance companies for consideration.

Some facilities use medical billers and coders. Other facilities use people who manage both areas of the claim process concurrently. A medical coder and biller and will typically earn higher than what an individual medical coder or biller. That’s because he/she is performing double responsibilities and eliminating the need for the health care facility to employ two different individuals.

Medical coders give the procedure codes and diagnostic codes that apply to the patient’s visit. A claim could be refused in the event the codes don’t match. The insurance provider will probably say the treatment wasn’t necessary. For this reason, it’s really essential for a medical coder to be accurate.

A medical biller obtains the right codes from the medical coder. He/she uses the codes to fill a claim form out. The claim is submitted to the insurance provider, usually in the kind of a digital claim. It is necessary the medical biller comply with all the requirements of each insurance provider. Several have special guidelines that have to be followed. In the event the claim form just isn’t filled out correctly and as stated by the insurance provider’s regulations, the claim may be delayed or refused. You may read more about medical billing at

Medical billing software is frequently used in medical claims processing. The software saves time and removes common errors. Medical billing software enables medical coders to look up procedure codes and diagnostic codes through the medical claims processing software as opposed to a manual. The software also assesses databases to make sure that the procedure codes and the diagnostic codes match up, avoiding the refusal of claims due to disparities.

Medical claims processing is a job which can be carried out from home. A lot of people have started their particular home businesses. This is an excellent medical claims processing method for stay-at-home moms to get an extra income and still stay at home with their kids.