When a patient receives medical treatment and has health insurance, they file a medical claim. A medical claim is the channel through which doctors bill insurance companies. It involves several steps and depending on the insurance company, an automated process, or a manual task. It is in everyone’s interest that the medical claim process goes as fast as possible.
Therefore, in this article, let us study this process in detail and learn five ways to improve medical claim processing.
What is Medical Claims Processing?
Medical claims processing is also known as claim adjucations. After the patient files the claim, the insurance company must review it. The insurance company then decides to pay the claim in full, partially, or deny the claim. Payment depends on the policy, the patient and the procedure, medicine, or doctor.
So, how does medical claim processing work and how is adjudication decided?
The 5 Steps to the Medical Claim Process
There are five steps to medical claims processing, the most key factor is speed.
- Initial Processing Review: The claim adjuster reviews whether the identifying information presented in the claim matches the information attached to the claimant. Information includes patient name, ID, phone number, gender, etc.
- Automatic Review: The claim is reviewed to see if they are eligible for payment, claims are checked for specific items that apply to each individual policy.
- Manual Review: Medical claim examiners review the claim involving a doctor or a nurse and the claimant’s medical records.
- Payment Determination: The claim adjuster measures responsibility, thus deciding how much (if anything) the insurance company will pay. The 3 types of determination are:
- Paid: Assumes full economic responsibility
- Reduced: Determines to pay a portion of the claim
- Denied: Rejects any payment for the claim
- Payment: If the insurance company decides to pay for the claim, the insurance company contacts the policy holder and reimburses them for the claim.
How Can I Solve an Insurance Claim Faster?
A successful claim management process depends on efficiency. The more time that goes by, the more expensive the claim becomes, this is not a product of chance. People filing medical insurance claims depend on the payment for medical attention.
In addition, here are five ways to improve management to speed up the medical claim process:
- Use Data
Data can benefit you. Benchmarking reveals valuable information about the frequency of claims. It can also reveal locations, types of claims, and what parts of the claim management process you can improve. - Comprehensive Task Management
Information is everything when handling a claim. Make sure you record as much as you can and keep track of all the moving parts on a claim! That way, everyone involved stays up to date. - 24-Hour Rule
Time is everything when it comes to a claim. Delayed response times and misunderstandings sends a message to the insured that the insurance company is not concerned. Increase your odds of a good outcome and aim to make initial contact within 24 hours. - Bring Outside Help
It is important to know that if you need help, furthermore, there are tools designed to handle claim management in a cost-effective and time-efficient manner. - Use Dashboards & Graphics
A picture is worth a thousand words. Moreover, dashboards make information easier to process and understand. Make sure you channel all the data you have on a dashboard. It will make it even easier to detect any issues.
Building a Better Medical Insurance Claims Process
Overall, There is one groundbreaking improvement for your claim management process: claim management software. Claim management software helps improve the claim management process because it provides:
- Automation of repeated and necessary tasks
- Faster processing because the source of information is trustworthy
- A centralized location for information
When someone’s claim is resolved quickly, they are less likely for them to seek litigation. The simple action of implementing claim management software to speed up claims will save you years of headaches. It is vital to be as timely as possible!
TerraClaim automates notifications, reminders, uses Machine Learning (ML) Technology, and Artificial Intelligence (AI), and more!
See for yourself by requesting a demo.
