Insurance Claim Adjudication
After checking the claim, if all mandatory
fields are filled, Insurance Company adjudicates the claims and makes decision
on the claim. The decision will be communicated to provider and also to the
patient. The decision will be called as Explanation of Benefits (EOB).
Cash posting
Updating the payment or denial into the
system. Based on the EOB Allowed amount, deductible, coinsurance, copay,
other patient responsibilities, refunds, offsets will be captured.
Denial Management
If the EOB says it is the denied claim, the
denial management team will work on the claim. The denials happen because of
Patient Eligibility, Coverage issues, Credential Issues, Authorization Issues
etc.,
AR Follow up
Accounts receivable team will follow up on
Claim status, Denied claims, Appeals, Underpayment Analysis and Patient Follow
ups.
Collection Process
Incase patient is not paid the balance after repeated statements. Claim sent to collection agency to collect the balance from patient.
Incase patient is not paid the balance after repeated statements. Claim sent to collection agency to collect the balance from patient.
