Medical Claim Creation & Submittal

In lesson 6, we discussed the process of creating and submitting claims. This includes gathering patient and provider information, entering it into a practice management software, creating a batch of claims, and submitting them to a clearing house or individual insurance payers. The clearing house is beneficial because it checks for errors and allows for one file to be sent to multiple payers. Claim attachments can also be sent electronically through the clearing house. Once the claim is accepted by the payer, it still has to go through an adjudication process and can be adjusted or denied if it does not comply with their guidelines.