Claims Submission

An Insurance Claim is more a prescribed request to an insurance firm requesting for a payment based on the clauses in the patient’s insurance policy. The company validates and reviews the claim and the same once approved, is given to the insured or to the office on behalf of the insured.

As per Investopedia, “insurance claims can be anything from a regular doctor visit to hospital admission, medical tests and even death benefits on life insurance policies. The claims can be filed by third parties on behalf of the insured person, and the person listed on the policy would always be the beneficiary.”

Types of Claim

Clean claim- A clean claim basically means a claim that is submitted without any extra information or details requested. This type of claim does not include any pending, denied, rejected or claims pending reviews.

Unclean redundant claim- This is a claim that is sent back to the billing office or the practice seeking more information.

Clean redundant claim- A clean redundant or rejected claim is basically sent back to the provider or billing office due to non-entitlement to the service or the person is not eligible.

Benefits of Electronic Claims Submission

  1. The claims submissions are made real-time, either electronically or manually to the payers or the bill clearing houses.

  2. Claims submitted electronically, generate an immediate notification about receiving the claims receipt, payment and its position.

  3. Medical practices can maximize claims submissions, expect faster processing, minimize resubmissions and rejections, practices have a better control and are more accurate and overheads can be reduced.

  4. Once claims are submitted, errors if any can be detected, and the status of the same is known on an immediate basis and action if required, can be taken accordingly.

  5. Electronic claims lessen bookkeeping and accounting paperwork as it is processed in lesser time than manual claims submission.

  6. When claims are sent out on a timely basis, and the status of the claim is recorded, then these reports make it easier to track the status and respond to the situation. And therefore lesser time is spent on constant follow-ups.

  7. Automated error-checking and detection happens and therefore there are lesser rejections based on incorrect or wrong claims.

  8. Savings in terms of being environmentally conscious and reduced usage of postage, envelopes and paper can be avoided. Also delivery costs, courier charges can also be eliminated.

  9. The cash flow is augmented and is steady as outstanding receivables and claims submission charges are reduced and thus increases the accounts receivables quotient.

  10. When submitting claims electronically, the physician or provider has access to any electronic HIPAA regulated or compliant procedures.

  11. On an average, the TAT for receiving payments is anywhere between 5-7 weeks for manual or paper claims submission and it is just a fortnight for electronic claims submissions.

  12. Human errors, or illegible writing or wrong code entries can be avoided when claims are submitted electronically.

  13. A paper claim in duplicate or additionally should never be made when it is already submitted electronically.

Work Flow

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