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Steps In The Process Flow
March 22, 2020
Steps In The Process Flow
- Auto accident takes place
Get proper medical care.
- Claim is filed with Insurance Company
For many insurers payments and remittance advisements are created using different systems—if not separate claims specialist units—with the payment check or draft approved and generated within the claims management system, while the remittance advice is generated by the bill review system.
- Treatment is sought after from a Medical Provider
A person should be treated immediately to determine how seriously you are injured, and to prescribe the best treatment for you -- to help you recover more quickly, and to make you as comfortable as possible while you are recovering.
- Treatment is given by Medical Provider
Medical provider provides urgent care to patients who have traumatic injury, major illnesses or other issues that require immediate treatment. The staff includes physicians, nurses and other healthcare professionals who follow specific procedures so that you can get the care you need as quickly as possible.
- Bills are generated for services rendered
Biller creates the medical claim, he or she is responsible for ensuring that the claim meets the standards of compliance, both for coding and format.
- Bills are sent to Insurance company for payment
Achieving necessary compliance in medical billing is ensuring that fees are charged accurately. The medical biller must confirm that each charge is related to a specific procedure code.
- Insurance company validates bills against existing claims
Health insurance administrative data are an important source of information for medical research. Analyses of insurance claims data were reported in at least 200 published articles in 2004. They are a rich and relatively inexpensive source of research information for studies of health care utilization and medical expenditures.
- Bill review is done to align to benchmark charges
It is important to continuously monitor bills to ensure that you are being charged correctly on both utility and third-party generation costs.
- Payment and EOB are issued to provider
At the end of the medical bill review process the insurer is required to produce and deliver a payment check (or draft) and a form of payment remittance advice; usually in the form of an explanation of benefit (EOB), explanation of reimbursement (EOR) or explanation of payment (EOP).
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