Chapter 1: Claims Processing Flashcards
1
Q
What is the first process for every insurance claim?
A
Verifying if the patient is eligible for benefits under policy.
2
Q
What is the second process for every insurance claim?
A
The company determines if the policy cover the procedures, services, and supplies the patient received.
3
Q
Is any procedure or service reported on the claim that in not included on the policy’s master benefit list?
A
No.
4
Q
Does a Noncovered benefit will be paid?
A
No.
5
Q
What is the third process for every insurance claim?
A
Determine if the diagnoses justify the treatment provided-medical necessity.
6
Q
What is the fourth (last) process for every insurance claim?
A
The insurance company will make a payment or explain why it not possible for paying.
