Follow the main stages of a medical claim, from patient registration and charge capture through payer adjudication, payment posting, and accounts receivable follow-up.
1. Register and verify
Collect accurate patient and insurance details, confirm active coverage, and identify authorization requirements before care is delivered.
2. Document, code, and submit
After the visit, the clinical record and charge information are reviewed, coded, and checked for completeness. A clean claim is then submitted to the appropriate payer.
3. Post, reconcile, and follow up
When the payer responds, payments and adjustments are posted, denials are routed for review, and unpaid balances are followed through to resolution.
- Compare the remittance to the expected payment.
- Appeal or correct claims when a payer decision needs action.
- Use aging reports to prioritize outstanding accounts.
Continue reading on Ceptrum360
This local article is a concise summary. Open the original for the complete reference article.
Read the full article ↗