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

Info icon This 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
Image of page 1

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

View Full Document Right 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 physician. The purpose of the initial processing is to entered all information into the
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern