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.


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