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.


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