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How Medical Claims Processing Works Medical billing entails a process whereby one party, the healthcare provider, forwards documents to the next party, the insurance company, seeking payment for the medical services offered to one of their clients. The process is carried out in all insurance companies, whether public or private. The patient’s diagnosis and treatment information is included in the medical coding. Many people are now able to gain access to an affordable health care throughout the U.S. They have had a positive impact on the way healthcare is provided in the country. For decades, the process of submitting these medical documents was done on raw paper. It involved faxing of copies of documents to and fro through the entire process. Before a resolution was reached by both parties, it took a long time. The evolution of technology has allowed for this process to be made entirely electronic. Technology like medical billing processing software has replaced the manual labor. EDI Billing has improved the speed of filing these claims and has improved the communication channels. The health information system is well capable of handling a lot of claims at a go. It has allowed room for instant feedback and real-time update of data. Businesses and companies have emerged after realizing the opportunities that are presented by these changes. Due to the rising demand for this software, technology companies have risen to the occasion and have provided hospitals and insurance companies with the best solution. The software has also improved the communication channel between the transacting parties.
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Another industry that has been on the rise is the medical billing clearinghouses. The main function of these clearinghouses is to act as intermediaries where they forward the medical claim from the hospital to the insurance firm. They also conduct a process known as claim scrubbing which is to regularly check the data for any errors. Another function is to determine if the claim provided by the hospital is indeed compatible with the claims processing software of the health insurance firm.
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The process of filing a claim may take longer than anticipated, especially if the provider and the payer are both enrolled in different claims clearinghouse. Whenever such a scenario arises, parties involved should be prepared for the claim to be moved into different stages and may keep moving to and fro. The process means that there are higher chances of the claim getting lost and falling into the wrong hands. To be protected from such a scenario, the healthcare providers are always advised to make sure that they know where the claim will go next after the clearinghouse.