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How Medical Claims Processing Works The process of medical billing involves the hospital sending documents to the insurance company showing the amount owed due to the medical treatment offered. The process is carried out in all insurance companies, whether public or private. The patient’s diagnosis and treatment information is included in the medical coding. Health insurance has allowed many people to gain access to affordable healthcare in the United States. They have revolutionized the way healthcare works. Traditionally, the process of filing medical billing was entirely done on paper. It involved faxing of copies of documents to and fro through the entire process. It took a long period for both parties to come to a resolution. The evolution of technology has allowed for this process to be made entirely electronic. Manual work of filing medical billing has been replaced by the medical claims processing software. EDI Billing has improved the speed of filing these claims and has improved the communication channels. The new technology can handle a huge number of claim filing at once. Feedback is now received and sent very fast and data can be updated instantly. The process has also opened doors of opportunities for many people and has resulted in the formation of big companies. Software and technology companies realized the potential of medical claims processing and have done their utmost best to provide hospitals and insurance companies with the best solution. The communication channels between the insurance company and the hospitals have also been improved by the claim processing software.
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These changes have also brought about the birth of medical billing clearinghouse. These clearinghouses act as an intermediary whereas they help the hospital to submit the claim to the insurance company. Clearinghouses also conduct claim scrubbing which is checking for errors related to the claim. They also double check to ensure that the hospital’s claim is compatible with the health insurance’s claims processing software.
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The process of filing a claim may take longer than anticipated, especially if the provider and the payer are both enrolled in different claims clearinghouse. This means that the claim will be forwarded from one clearinghouse to the next and the process might go to and fro. The process means that there are higher chances of the claim getting lost and falling into the wrong hands. To be protected from such a scenario, the healthcare providers are always advised to make sure that they know where the claim will go next after the clearinghouse.