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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. Medical billing is conducted on all health insurance whether they are government sponsored programs or private companies. Medical coding is used to entail what the diagnosis was all about and the cost of the treatment conducted. Health insurance has allowed many people to gain access to affordable healthcare in the United States. 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. Time wastage was common before both parties came to an agreement. 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. The EDI billing as they are known, have managed to make the entire process fast and has allowed for both parties to reach an agreement fast. The health information system has allowed hospitals to manage a huge number of claims at once. 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. Software and technology companies realized the potential of medical claims processing and have done their utmost best to provide hospitals and insurance companies with the best solution. The claims processing software has also improved the channel of communication between the vendor (health insurance) and the subcontractor (hospitals).
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These changes have also brought about the birth of medical billing clearinghouse. The main function of these clearinghouses is to act as intermediaries where they forward the medical claim from the hospital to the insurance firm. Clearinghouses also conduct claim scrubbing which is checking for errors related to the claim. They also check to see if the claim is compatible with the software of the insurance provider.
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The entire process might take a long time, and it is further complicated in case both parties are enrolled in different clearinghouses. 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. It also means that the chances of your claim becoming stale or getting lost will also increase. It is always better to ask your claims clearinghouse where the claim will go after it leaves their office so as to avoid any unnecessary delays or loss of information and data.