CAPSTONE CHECKPOINT HCR-230 - CAPSTONE CHECKPOINT The...

Info iconThis preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
CAPSTONE CHECKPOINT The Adjudication Process Initial processing Automated review Manuel review Determination Payment Paper claims and attachments are date stamped and entered Potential errors …ie, Name, ID, CPT code…. Forms with errors are rejected and sent back for corrections Patient’s eligibility of benefits Time limits for filing claims Preauthorization and referrals Duplicate dates of service Non-covered services Valid code linkage Medical & utilization review Concurrent care Problems with automated review??? Claims examiner to review ….place of service, treatments were appropriate, & services provided were accurate in report Pay it, deny it or pay at reduced level Payment sent with RA, ERA, or EOB
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Flow Chart Explanation In the five steps of the adjudication process the first step is the initial processing. Initial processing begins after the physician sends the claims report to the payer, and after the payer receives the report a successful transmission message is sent back to the
Background image of page 2
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 10/11/2010 for the course MAT 116 AAGN098SN3 taught by Professor Britt,j during the Spring '10 term at University of Phoenix.

Page1 / 2

CAPSTONE CHECKPOINT HCR-230 - CAPSTONE CHECKPOINT The...

This preview shows document pages 1 - 2. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online