Unformatted text preview: limit for filing claims, referral forms, preauthorization, and the patient’s benefits eligibility. Also checked during the automated review process are bundled codes, non covered services, medical reviews, concurrent care, utilization review, and duplicate dates of service. If any problems are found during the automated review it is then set aside and goes through the third step which is manual review. During the manual review process information is collected so that the claim can be finished. For example if there are errors found the personnel working on the manual review can as the physician for any additional information to process the claim. Once all errors are collected the process goes into the fourth step which is determination. During the determination step the decision for payment is made, denied or reduced. Finally the claim is paid (if accepted), sent to provider with an explanation of decision....
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- Fall '11
- Physician, Credit card, claim adjudication process