Claims Adjustment process week 9

Claims Adjustment process week 9 - Running head WEEK 9...

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Unformatted text preview: Running head: WEEK 9 CAPSTONE CHECKPOINT 1 Week 9 Capstone Checkpoint Emerald Allen HCR/230 November 23, 2011 Samantha Pinto WEEK 9 CAPSTONE CHECKPOINT 2 Week 9 Capstone Checkpoint The first step in the claims adjustment process is the Initial Processing. The claim is put through initial processing and is checked by the payer’s front-end claims processing system for any type of errors. The claims are then stamped with the date and processed through a computer system or either by data-entry personnel and sometimes by the use of a scanning system. The claim goes through initial processing to see if there are such problems as patients name identification number or place of service codes are wrong. Also if the diagnosis code is missing and if there is a valid date as well as the correct sex for the gender-specific procedure. The claim has to be made sure the patient is still eligible. The next step is the Automated Review process; this applies to any type of edits that are made to the medical claim. This can be patient eligibility, this applies to any type of edits that are made to the medical claim....
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Claims Adjustment process week 9 - Running head WEEK 9...

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