Claims adjudication process

Claims adjudication process - Claims adjudication process...

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Claims adjudication process The first step in the claim adjudication process is the initial processing. This processing is when the paper claim and any attachments are date stamped and entered into the payer’s computer system. This step checks the claim for errors such as the patients name, plan identification number, place of service code, missing diagnosis code, diagnosis code invalid for service date, or incorrect sex for gender specific procedure. If any of these mistakes are made, the claim is rejected and the provider is given instructions to correct the errors and re-bill the service. The next step in the claim adjudication process is the automated review to check the payment policies and applies edits for Medicare claims or Medicaid claims. This steps checks to make sure the patient is eligible for benefits, the time frame the claim was filed, for preauthorization or referrals for services, duplications for dates for services, non-covered services, valid code linkages, bundled codes, medical review
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This note was uploaded on 10/16/2011 for the course HCR230 HCR230 taught by Professor Valerie during the Spring '11 term at University of Phoenix.

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Claims adjudication process - Claims adjudication process...

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