Auto Insurance Claims Information, insurance claims processing.#Insurance #claims #processing


Insurance Claims

Because the moments following a car accident can be stressful and filled with distractions, it’s important to understand how your insurance company handles auto insurance claims before you’re involved in an accident.

We’ve compiled information related all types of auto insurance claims, including bodily and personal injury claims, accident claims involving property damage, and how to tell the difference between a routine insurance claim and one for which you might need legal assistance. Understanding these factors before an auto accident means you can take the proper steps to document and report every kind of injury and accident loss, thus increasing your chances of being fairly and swiftly compensated.

Claims Types and Filings

In these pages, you’ll find important info on car insurance claims including why car insurance rates go up after accidents.

Tips on filing car insurance claims following an auto accident. Find simplified info on how & when to report car accidents to an auto insurance company.

Find important information on how the claims process is handled from initial report, to working with an insurance claims specialist to the final settlement.

Find information on car insurance claims with an emphasis on accident-related injuries.

Legal Representation, Settlements and FAQs

Find information on auto insurance claim settlements & handling an auto accident through a car insurance company.

Information on legal representation & auto accident lawsuits. Find out more on hiring an attorney such as a personal injury lawyer if you are involved in a car wreck.

Learn the answers to some common questions about filing claims with your car insurance company.

Insurance Claims Articles

Learn how to file an auto claim after a car accident. Our guide to car insurance claims shows you how to deal with auto insurance adjusters, negligent parties & more.

Let’s look at 5 scenarios to determine if your car insurance company will cover you if you damage your own property.

Learn about car insurance fraud and auto theft and ways in which it can affect your car insurance rates.


IHCFA Claims Processing, Home, insurance claims processing.#Insurance #claims #processing


insurance claims processing

iHCFA Well Positioned to Support New Jersey s EDI Law for Electronic Filing of Medical Bills for Worker s Compensation Claims

Morristown, NJ. (November 14, 2016) – iHCFA, LLC an industry leading clearinghouse, specializing in the electronic processing of Workers Compensation and Automobile bills, announced today that it is poised to support healthcare Providers and insurance payors in implementing the new S-2136 Electronic Data Interface (EDI) bill signed into law today by New Jersey Governor Chris Christie.

The new law requires all Workers Compensation, Third Party Administrators and Employers who receive medical bills to accept the bills and their medical reports electronically. All healthcare Providers and Hospitals that submit over twenty-five (25) bills per month are also required to submit their bills and medical reports electronically. The Department of Banking and Insurance will utilize the national standard ASC X-12 electronic data exchange protocols found in all modern billing systems.

Company President, Dr. William J. DeGasperis, stated, this law moves New Jersey into the 21 st century and will result in lower costs, greater accountability, productivity and a better working relationship between the Provider and insurance payor. iHCFA is uniquely positioned to help clients comply with this new law because of our ability to connect to any medical billing system and link to more than 1,000 insurance payors and third-party administrators, said DeGasperis.

The benefit for healthcare providers managing their revenue cycles through e-billing, besides faster payment, is the increased efficiency of direct point to point communication between the insurance carrier and the Provider billing system. The elimination of lost bills and an overall reduction in administrative costs and burdens results in a more effective, efficient process. Providers currently submit over 95% of all Medicare, Medicaid and healthcare bills electronically yet submit only 10% of all Workers Compensation and Auto bills. Payors receive faster notification of claims through the e-billing process, more accurate and complete first-time bills and medical documents, better communication and a significant reduction in paper and mail room processing. These all lead to decreased costs and eliminate reliance on antiquated manual processing.

iHCFA, a New Jersey based clearinghouse, specializes in electronically processing Workers Compensation and Automobile bills with all supporting documents. iHCFA is an industry leader with the ability to connect to any medical billing system and link to more than 1,000 insurance payors and third-party administrators in all 50 states. iHCFA users can access a web based system to perform bill validation, review processing status including acceptance or rejection and payment notifications.


Medical Claims Processing, Apex EDI Billing Clearinghouse, insurance claims processing.#Insurance #claims #processing


Medical Claims Processing

Stop sending claims the old-fashioned way. We ll save you time and money!

Process your electronic claims with Apex EDI and get paid faster, 5-12 days.

OneTouch ® electronic claims delivery is fast, convenient, and affordable!

Our Clients are Big Fans

We deliver Wow! through caring.

This has been one of the best decisions I ever made. Our payments are arriving much faster than ever before and we are not having to do any duplicate filing.

John A. McCall Jr., OD

We have been very pleased with the service Apex has provided to our office. It has saved much time and hassle getting claims paid in a shorter time period.

Dr. M Kelly Soutas

I strongly recommend that all medical and dental providers and billing services consider using Apex EDI as an effective tool to reduce administration costs

I would like to take a moment and express my gratitude. Our transition to Apex has been the smoothest transition I have ever been involved with. From the moment

I couldn t be happier with the level of service that I have received; from the first day I felt I was in very capable hands. I look forward to the day I can pass on

By taking advantage of Apex we have cut our billing time down significantly, and payments from insurance companies are coming in a quick, concise, and

I just wanted to let you know we are seeing payments and the turnaround time is AMAZING! Apex is allowing us to collect so much faster than before, and

News Events

Medical billing is a complex task where many things can go wrong. It takes

Telemedicine is not a passing trend. It’s the future of healthcare, with

The U.S. recently faced back-to- back major hurricanes. Texas and Florida h

Thousands of practices use our products and services to increase productivity and improve patient care.

Apex EDI takes the headache out of processing medical claims, dental claims, optometry claims, and chiropractic claims. Our solutions simplify the claims delivery process. We offer OneTouch ® electronic claims processing, real-time eligibility verification, patient statements delivery, and electronic remittance advice (ERA) and tools that accelerate the patient payment collection process.

Insurance claims processing

Partners

Apex EDI has created the OneTouch ® solution to offer you an easier and less expensive way to process your insurance claims electronically and receive faster reimbursement.


Claims, TOPA Insurance, insurance claims processing.#Insurance #claims #processing


Insurance claims processing

Topa Insurance Company recognizes that it is essential to know you can rely on your insurance company to be there in your time of need. With our committed and experienced staff of Claims professionals, we aim to provide efficient, fair, quality claims service that will exceed the expectations of our valued Topa policyholders.

If you or another Topa Insured:

  • Become aware of an accident or incident causing damages or injuries
  • Participate in an event or occurrence which may lead to a covered claim
  • Receive verbal or written notice that a claim may be made against you

Act immediately and do the following:

  • Get all the details including names, addresses and phone numbers of all parties involved
  • Record the date, time and place of occurrence and the nature of the claim
  • Preserve and safeguard any physical evidence
  • Do not make any commitments or attempt to handle the claim yourself
  • Contact Topa Express Claims Reporting immediately
  • Send all written communications to the following:
    • P: 818.466.5900

    Toll Free: 877.353.8672

    F: 818.616.7048

  • Topa Claims

    Call and speak to a Topa Claims Manager if you have any concerns or questions

    Your quick response in identifying and reporting claims promptly will assist our staff in meeting their commitment to you and can positively impact the final results. Please review your policy and become familiar with the protection it provides. For questions regarding coverage, please contact your retail agent through whom you acquired your policy.

    Report a claim

    In an effort to expedite the processing of your claim, please email [email protected] with the following:

    • Policy Number
    • Policy Holder s Name (Name Insured)
    • Insured s
      • Street Address (City, State, Zip)
      • Contact Name
      • Phone (please provide two when possible)
    • Date Time of Loss
    • Location of loss (Address, City, State, Zip)
    • Loss Description (describe what happened)
    • Witness information (Name, Phone), please provide two when available
    • Injured/Damaged Party information
      • Name
      • Company (if applicable)
      • Street Address (City, State, Zip)
      • Phone (please provide two when possible)
      • Nature of injury /or property damage
    • Reporter Information
      • Name
      • Relationship to Insured
      • Report Date
      • Phone (please provide two when possible)
      • Email Address
    • Any attachments

    Report Fraud

    Topa Insurance Company is committed to providing quality insurance products along with outstanding service at reasonable prices. Insurance Fraud increases costs for everyone and, in some cases, can put you, your family and friends at risk. As part of our commitment to combating fraud, we maintain an active Special Investigation Unit (SIU) and support the National Insurance Crime Bureau (NICB) .

    We encourage you to join us in this anti-fraud effort by reporting any suspicious, counterfeit, or inflated claims. This can be done anonymously simply by calling 1-800-TEL-NICB (1-800-835-6422) or by reporting online at

    Insurance claims processing


Processing Medical Claims from Home, Medical Claims Processing at Home, medical claims processing jobs.#Medical #claims


Processing Medical Claims From Home

What’s involved with processing medical claims from home? Learn from a medical billing home business owner the specifics of medical claims processing at home, how it works, and what you need to process claims.

In this day and age everybody wants the flexibility to be able to work from home. One of the more popular is medical billing jobs from home which involves medical claims processing at home. However there’s more to it than just entering data on a computer.

Processing medical claims from home involves entering patient and provider information along with the appropriate ICD-9 (or ICD-10) diagnosis and CPT treatment medical billing codes . The patient information is insurance ID, address, phone, responsible party, age, etc. Provider information is NPI number, name, address, practice name, etc. The diagnosis and treatment codes are usually obtained from the superbill. However those performing medical coding from home will take the doctors notes and assign the diagnosis and treatment codes.

The key is the information must be provided in a secure manner to comply with HIPAA security and privacy standards. Probably the best way is either via scanned document stored on a secure server or transmitted via secure email. Faxing patient information can be dangerous because if the information can be mistakenly sent to the wrong fax number. Many fax machines have pre-programmed numbers and it’s easy when things are busy to fax to press the wrong button. I’ve been on the receiving end of a few of these misguided faxes. There’s also the concern that you never know how secure the destination fax is. It could be open to anyone walking by and you don’t want patient info exposed like this.

There’s also the option of physically picking up the info to be processed at the providers office. Some billing services or those who work for a practice and are processing medical claims from home will arrange to pick up on a pre-determined schedule – like once a week or a couple times a week. But most busy practices need claims processed promptly to get paid. The caution here is that the information be protected on its route and not left unprotected in the couriers car.

Insurance claims can be processed one of two ways; via paper or electronically. The link above gives a more detailed description of claim processing, including a flowchart showing the claim process.

Of course this is done using a medical claims billing software of which many varieties are available. Those processing medical claims from home need to have this software on their PC or access to it via internet. If you are working from home for a doctor’s office, you would require remote access to the practice server where the medical claim billing software resides. This typically done via Windows Remote Desktop or some other secure means via the internet.

For those operating their own healthcare billing service, they would typically use their own billing claim medical software running on a local computer or server. However online medical billing software is becoming more popular that allows access using a web browser. This is nice because it doesn’t require any special software to be installed and you don’t have to worry about backing up data or secure servers, etc.

Paper claims simply require printing the claims on the pink CMS-1500 forms and mailing to the different insurance companies. Sending claims electronically involves creating a file (or batch file) and transmitting or uploading the file to the clearinghouse or insurance company. This is typically done through their website. Once claims are submitted the clearinghouse and/or insurance carrier will generate a report indicating if the claims were accepted. If they were rejected the report should give the reason why it was rejected so the claim can be corrected and resubmitted.

Most rejections on the front end (when initially submitted) are a result of errors or typos in dates, insurance IDs, names, coverage dates, errors in codes, etc.

Usually the person processing medical claims is also responsible for other tasks related to billing. Medical claims processing from home can also involve following up on denied claims, correcting and re-submitting these claims, appealing denied claims, posting insurance and patient payments, answering patient questions regarding their bill, etc. Here’s more info on all the medical billing specialists responsibilities . The biller is usually expected to “own” the claim from creation to payment and everything in between necessary to get it paid.

If you work for a doctor’s office or billing service a typical medical billing salary ranges from $10 an hour to over $15 an hour. Depends on experience and who you work for. Most people processing medical claims from home are more experienced and will be on the higher end of the range – and can be well over $15 an hour. I’ve heard of some who are really valuable to a practice making closer to $20 an hour. If you operate a medical billing home business, the pay can be higher depending on the practice being service and the negotiated fees.

Since processing medical claims from home can be done via computer, all you really need is a computer and high speed internet connection. Most health insurance claim software runs on Windows computers or servers so a Windows PC is best here. I’m sure there are some Mac based systems but I haven’t seen any and wouldn’t really want the complexity of trying to work out Mac verses Windows issues.

It’s also important to have an office or workspace that can be secured when not in use. This is to protect any provider and patient data from unauthorized eyes.

Probably most important is to have the opportunity for processing medical claims from home. This is only possible if you work for a practice, hospital, or physicians billing service that allows you to work from home – or if you have your own medical billing home business.

Typically working from home for an employer requires a level of trust that comes with a lot of experience in the field and working for this particular employer. You may see advertisements for home medical billing jobs or medical claims processing at home but they are usually thinly disguised attempts to make money for some overpriced business opportunity. So be wary of these ads – if it sounds too good to be true it probably is.

If you have worked for a practice as medical billing specialist and have a good relationship with the doctor or office manager, this would be a good opportunity to approach them about medical claims processing at home.

Operating a medical billing business requires training and knowledge to be successful. The financial success of a doctors practice and those they employ is dependent on a good medical billing specialist. And they aren’t going to turn this responsibility over to just anyone they don’t feel will improve their present situation. Being a successful medical billing business owner requires training in the field, the ability to produce results for your client, and convincing a doctor to entrust you with the billing.

In summary processing medical claims from home is viable. It takes the right situation or opportunity, training, and a good knowledge of medical billing. From my experience it requires self motivation and the ability to separate home from work, but it sure beats going into an office every day.

Recent Articles

Is it possible to work in Medical Billing or Coding at night instead of during the day?

Oct 23, 17 09:16 PM

How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I’m an

Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

Oct 23, 17 09:15 PM

Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

What is the CPT code for ‘Male Hormone Panel’

Oct 23, 17 08:57 PM

What is the CPT code for ‘Male Hormone Panel’ . testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We’ll post in hopes our Visitors

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.

Copyright 2017 All-Things-Medical-Billing.com

Medical claims processing jobs

Medical claims processing jobs


Processing Medical Claims from Home, Medical Claims Processing at Home, claims processing.#Claims #processing


Processing Medical Claims From Home

What’s involved with processing medical claims from home? Learn from a medical billing home business owner the specifics of medical claims processing at home, how it works, and what you need to process claims.

In this day and age everybody wants the flexibility to be able to work from home. One of the more popular is medical billing jobs from home which involves medical claims processing at home. However there’s more to it than just entering data on a computer.

Processing medical claims from home involves entering patient and provider information along with the appropriate ICD-9 (or ICD-10) diagnosis and CPT treatment medical billing codes . The patient information is insurance ID, address, phone, responsible party, age, etc. Provider information is NPI number, name, address, practice name, etc. The diagnosis and treatment codes are usually obtained from the superbill. However those performing medical coding from home will take the doctors notes and assign the diagnosis and treatment codes.

The key is the information must be provided in a secure manner to comply with HIPAA security and privacy standards. Probably the best way is either via scanned document stored on a secure server or transmitted via secure email. Faxing patient information can be dangerous because if the information can be mistakenly sent to the wrong fax number. Many fax machines have pre-programmed numbers and it’s easy when things are busy to fax to press the wrong button. I’ve been on the receiving end of a few of these misguided faxes. There’s also the concern that you never know how secure the destination fax is. It could be open to anyone walking by and you don’t want patient info exposed like this.

There’s also the option of physically picking up the info to be processed at the providers office. Some billing services or those who work for a practice and are processing medical claims from home will arrange to pick up on a pre-determined schedule – like once a week or a couple times a week. But most busy practices need claims processed promptly to get paid. The caution here is that the information be protected on its route and not left unprotected in the couriers car.

Insurance claims can be processed one of two ways; via paper or electronically. The link above gives a more detailed description of claim processing, including a flowchart showing the claim process.

Of course this is done using a medical claims billing software of which many varieties are available. Those processing medical claims from home need to have this software on their PC or access to it via internet. If you are working from home for a doctor’s office, you would require remote access to the practice server where the medical claim billing software resides. This typically done via Windows Remote Desktop or some other secure means via the internet.

For those operating their own healthcare billing service, they would typically use their own billing claim medical software running on a local computer or server. However online medical billing software is becoming more popular that allows access using a web browser. This is nice because it doesn’t require any special software to be installed and you don’t have to worry about backing up data or secure servers, etc.

Paper claims simply require printing the claims on the pink CMS-1500 forms and mailing to the different insurance companies. Sending claims electronically involves creating a file (or batch file) and transmitting or uploading the file to the clearinghouse or insurance company. This is typically done through their website. Once claims are submitted the clearinghouse and/or insurance carrier will generate a report indicating if the claims were accepted. If they were rejected the report should give the reason why it was rejected so the claim can be corrected and resubmitted.

Most rejections on the front end (when initially submitted) are a result of errors or typos in dates, insurance IDs, names, coverage dates, errors in codes, etc.

Usually the person processing medical claims is also responsible for other tasks related to billing. Medical claims processing from home can also involve following up on denied claims, correcting and re-submitting these claims, appealing denied claims, posting insurance and patient payments, answering patient questions regarding their bill, etc. Here’s more info on all the medical billing specialists responsibilities . The biller is usually expected to “own” the claim from creation to payment and everything in between necessary to get it paid.

If you work for a doctor’s office or billing service a typical medical billing salary ranges from $10 an hour to over $15 an hour. Depends on experience and who you work for. Most people processing medical claims from home are more experienced and will be on the higher end of the range – and can be well over $15 an hour. I’ve heard of some who are really valuable to a practice making closer to $20 an hour. If you operate a medical billing home business, the pay can be higher depending on the practice being service and the negotiated fees.

Since processing medical claims from home can be done via computer, all you really need is a computer and high speed internet connection. Most health insurance claim software runs on Windows computers or servers so a Windows PC is best here. I’m sure there are some Mac based systems but I haven’t seen any and wouldn’t really want the complexity of trying to work out Mac verses Windows issues.

It’s also important to have an office or workspace that can be secured when not in use. This is to protect any provider and patient data from unauthorized eyes.

Probably most important is to have the opportunity for processing medical claims from home. This is only possible if you work for a practice, hospital, or physicians billing service that allows you to work from home – or if you have your own medical billing home business.

Typically working from home for an employer requires a level of trust that comes with a lot of experience in the field and working for this particular employer. You may see advertisements for home medical billing jobs or medical claims processing at home but they are usually thinly disguised attempts to make money for some overpriced business opportunity. So be wary of these ads – if it sounds too good to be true it probably is.

If you have worked for a practice as medical billing specialist and have a good relationship with the doctor or office manager, this would be a good opportunity to approach them about medical claims processing at home.

Operating a medical billing business requires training and knowledge to be successful. The financial success of a doctors practice and those they employ is dependent on a good medical billing specialist. And they aren’t going to turn this responsibility over to just anyone they don’t feel will improve their present situation. Being a successful medical billing business owner requires training in the field, the ability to produce results for your client, and convincing a doctor to entrust you with the billing.

In summary processing medical claims from home is viable. It takes the right situation or opportunity, training, and a good knowledge of medical billing. From my experience it requires self motivation and the ability to separate home from work, but it sure beats going into an office every day.

Recent Articles

Is it possible to work in Medical Billing or Coding at night instead of during the day?

Oct 23, 17 09:16 PM

How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I’m an

Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

Oct 23, 17 09:15 PM

Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

What is the CPT code for ‘Male Hormone Panel’

Oct 23, 17 08:57 PM

What is the CPT code for ‘Male Hormone Panel’ . testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We’ll post in hopes our Visitors

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.

Copyright 2017 All-Things-Medical-Billing.com

Claims processing

Claims processing


The medical billing insurance claims process, claims processing software.#Claims #processing #software


Medical Billing and Coding Online

The medical billing insurance claims process starts when a healthcare provider treats a patient and sends a bill of services provided to a designated payer, which is usually a health insurance company. The payer then evaluates the claim based on a number of factors, determining which, if any, services it will reimburse.

Let’s briefly review the steps of the medical billing procedure leading up to the transmission of an insurance claim. When a patient receives services from a licensed provider, these services are recorded and assigned appropriate codes by the medical coder. ICD codes are used for diagnoses, while CPT codes are used for various treatments. The summary of services, communicated through these code sets, make up the bill. Patient demographic data and insurance information are added to the bill, and the claim is ready to be processed.

Processing Claims

A number of technical protocols and industry standards must be met for insurance claims to be delivered expediently and accurately between medical practice and payer.

Medical billing specialists typically use software to record patient data, prepare claims, and submit them to the appropriate party, but there isn’t a universal software application that all healthcare providers and insurance companies use. Even so, insurance claims software use a set of standards, mandated as by the HIPAA Transactions and Code Set Rule (TCS). Adopted in 2003, the TCS is defined by the Accredited Standards Committee (ACS X12), which is a body tasked with standardizing electronic information exchanges in the healthcare industry.

There are two different methods used to deliver insurance claims to the payer: manually (on paper) and electronically. The majority of healthcare providers and insurance companies prefer electronic claim systems. They are faster, more accurate, and are cheaper to process (electronic systems save around $3 per claim). But because paper claims have not yet been completely removed from the insurance claims process, it is important for the medical biller and coder to be well versed with both electronic and hardcopy claims.

Filing Electronic Claims

Certain technologies have been introduced into the system in order to expedite claim processing and increase accuracy.

Some healthcare providers use software to electronically enter information into CMS-1500 and UB-04 documents. Using “fill and print” software eliminates the possibility for unreadable information. This software may also include certain types of “scrubbing,” or tools that check for errors in the documents. While these tools do decrease the amount of errors made in filling out claim forms, they are not always 100 percent accurate, so medical billers should remain diligent when filling out forms using software.

Optical Character Recognition (OCR)

OCR equipment scans official documents, electronically isolating and recording information provided in the different fields, and transferring (or auto-filling) that information into other documents when necessary. While OCR technology helps make hardcopy claim processing much more efficient, human oversight is still needed to ensure accuracy. For instance, if the OCR miscalculates a simple digit in a medical code, that error must be flagged and manually corrected by a medical billing specialist.

Note that when OCR equipment is not available, it is possible for a medical billing specialist to manually convert CMS-1500 and UB-04 documents into digital form using conversion tools called “crosswalks” (note that the same term applies for tools used to convert ICD-9-CM codes to ICD-10-CM). You can find crosswalk references from a number of different sources.

Filing Manual Claims

Paper claims must be printed out, completed by hand, and physically mailed to payers. The healthcare industry uses two forms to submit claims manually. Since processing paper claims requires more manual interaction with forms and data, the opportunity for human error increases compared to electronic claims. Documents can be printed improperly, and handwritten codes can be incorrect or illegible. The forms can also be mailed to the wrong address, with insufficient postage, or disrupted by logistical complications with the delivery services. These errors are costly for the healthcare provider, often resulting in form resubmission (a time-consuming process) and payment delays.

Generally, healthcare professionals like family physicians use form CMS-1500, while hospitals and other “facility” providers use the UB-04 form.

The CMS-1500 is the universal claim form used by non-institutional healthcare providers (private practices, etc.) to bill Medicare for Part B covered services and some Medicaid-covered services, and is accepted by most health insurance providers. The CMS-1500 is maintained by the National Uniform Claim Committee (NUCC), and was previously updated to include National Provider Identifiers (NPIs), or unique numbers required by the Health Insurance Portability and Accountability Act (HIPAA).

Form CMS-1500 contains all the basic information needed to submit an accurate claim. This includes fields for the patient’s demographic information, insurance information, and boxes in which to provide medical codes and corresponding dates of service. Certain boxes are used exclusively for Medicare and/or Medicaid. It is important to note that different payers may provide different instructions on how to complete certain item numbers. The medical biller and coder should be familiar with specific payer requirements before filling out the form.

Form UB-04, also maintained by the NUCC, is very similar to the CMS-1500, but it is used by institutional healthcare providers, such as hospitals. Like the CMS-1500, the UB-04 is used in lieu of electronic claims when the facility meets any number of exceptions granted by the ASCA. It is the responsibility of the facility to self-assess whether these designated exceptions apply to their operation, granting usage of manual claims. Also similar to the CMS-1500, certain payers may not require all fields, or data elements, to be completed.

The role of clearinghouses

Once a file is created using these standards, it is usually sent off to a clearinghouse. The clearinghouse is a third-party operation that primarily acts as a middleman between healthcare providers and insurance carriers.

Think of the clearinghouse as a central hub, or a single location where all claims are sent to be sorted and directed onward to all the various insurance carriers. Typically, clearinghouses use internal software to receive claims from healthcare providers, scrub them for errors, format them correctly in accordance with HIPAA and insurance standards, and send them to the appropriate parties. Clearinghouses generally keep medical practices in the loop during this process by providing reports on the status of claims.

This third party is necessary because healthcare providers typically have to send high quantities of insurance claims each day to a variety of different insurance providers. Each of these insurance providers may have their own submission standards. If a medical practice’s billing staff was solely responsible for transmitting insurance claims under both insurance and HIPAA requirements, the potential for error would increase dramatically, not to mention the time required for formatting each claim to specific insurance carrier.

When choosing a clearinghouse, a healthcare provider should consider two main factors:

  • Does the clearinghouse have the capability to work with the insurance providers the practice works with most often?
  • Can the clearinghouse accommodate claims transmissions from the insurance provider’s practice management software?

Confirming these questions ensures that all transmissions run smoothly.

Wrapping Up Course 5

Healthcare providers prepare insurance claims using information provided in the patient’s bill. Occasionally, the claim is prepared manually and sent by mail. In most cases, the claim is sent electronically (having either been prepared using claim software or scanned from a hard copy) to a clearinghouse. The clearinghouse checks the claim for errors, formats it according to HIPAA and insurance guidelines, then transmits it to the appropriate payer, while also sending a report back to the healthcare provider.

After the claim has been evaluated, the insurer must provide both the patient and healthcare provider with an Explanation of Benefits (EOB). The EOB breaks down the adjudication process, showing the dates of service, procedures and charges, patient financial responsibility, and the amount paid to the healthcare provider. At this point, the health insurer sends payment to the healthcare provider, usually in the form of an electronic fund transfer.

The insurance claims process can be complex. Fortunately, there are tools to help complete insurance claims on a day-to-day basis. Medical billing professionals who are familiar with these tools and all documents (both paper and electronic), industry standards, individual insurance company regulations, clearinghouse procedures, and the adjudication process will be prepared to succeed.


Processing Medical Claims from Home, Medical Claims Processing at Home, claims processing software.#Claims #processing #software


Processing Medical Claims From Home

What’s involved with processing medical claims from home? Learn from a medical billing home business owner the specifics of medical claims processing at home, how it works, and what you need to process claims.

In this day and age everybody wants the flexibility to be able to work from home. One of the more popular is medical billing jobs from home which involves medical claims processing at home. However there’s more to it than just entering data on a computer.

Processing medical claims from home involves entering patient and provider information along with the appropriate ICD-9 (or ICD-10) diagnosis and CPT treatment medical billing codes . The patient information is insurance ID, address, phone, responsible party, age, etc. Provider information is NPI number, name, address, practice name, etc. The diagnosis and treatment codes are usually obtained from the superbill. However those performing medical coding from home will take the doctors notes and assign the diagnosis and treatment codes.

The key is the information must be provided in a secure manner to comply with HIPAA security and privacy standards. Probably the best way is either via scanned document stored on a secure server or transmitted via secure email. Faxing patient information can be dangerous because if the information can be mistakenly sent to the wrong fax number. Many fax machines have pre-programmed numbers and it’s easy when things are busy to fax to press the wrong button. I’ve been on the receiving end of a few of these misguided faxes. There’s also the concern that you never know how secure the destination fax is. It could be open to anyone walking by and you don’t want patient info exposed like this.

There’s also the option of physically picking up the info to be processed at the providers office. Some billing services or those who work for a practice and are processing medical claims from home will arrange to pick up on a pre-determined schedule – like once a week or a couple times a week. But most busy practices need claims processed promptly to get paid. The caution here is that the information be protected on its route and not left unprotected in the couriers car.

Insurance claims can be processed one of two ways; via paper or electronically. The link above gives a more detailed description of claim processing, including a flowchart showing the claim process.

Of course this is done using a medical claims billing software of which many varieties are available. Those processing medical claims from home need to have this software on their PC or access to it via internet. If you are working from home for a doctor’s office, you would require remote access to the practice server where the medical claim billing software resides. This typically done via Windows Remote Desktop or some other secure means via the internet.

For those operating their own healthcare billing service, they would typically use their own billing claim medical software running on a local computer or server. However online medical billing software is becoming more popular that allows access using a web browser. This is nice because it doesn’t require any special software to be installed and you don’t have to worry about backing up data or secure servers, etc.

Paper claims simply require printing the claims on the pink CMS-1500 forms and mailing to the different insurance companies. Sending claims electronically involves creating a file (or batch file) and transmitting or uploading the file to the clearinghouse or insurance company. This is typically done through their website. Once claims are submitted the clearinghouse and/or insurance carrier will generate a report indicating if the claims were accepted. If they were rejected the report should give the reason why it was rejected so the claim can be corrected and resubmitted.

Most rejections on the front end (when initially submitted) are a result of errors or typos in dates, insurance IDs, names, coverage dates, errors in codes, etc.

Usually the person processing medical claims is also responsible for other tasks related to billing. Medical claims processing from home can also involve following up on denied claims, correcting and re-submitting these claims, appealing denied claims, posting insurance and patient payments, answering patient questions regarding their bill, etc. Here’s more info on all the medical billing specialists responsibilities . The biller is usually expected to “own” the claim from creation to payment and everything in between necessary to get it paid.

If you work for a doctor’s office or billing service a typical medical billing salary ranges from $10 an hour to over $15 an hour. Depends on experience and who you work for. Most people processing medical claims from home are more experienced and will be on the higher end of the range – and can be well over $15 an hour. I’ve heard of some who are really valuable to a practice making closer to $20 an hour. If you operate a medical billing home business, the pay can be higher depending on the practice being service and the negotiated fees.

Since processing medical claims from home can be done via computer, all you really need is a computer and high speed internet connection. Most health insurance claim software runs on Windows computers or servers so a Windows PC is best here. I’m sure there are some Mac based systems but I haven’t seen any and wouldn’t really want the complexity of trying to work out Mac verses Windows issues.

It’s also important to have an office or workspace that can be secured when not in use. This is to protect any provider and patient data from unauthorized eyes.

Probably most important is to have the opportunity for processing medical claims from home. This is only possible if you work for a practice, hospital, or physicians billing service that allows you to work from home – or if you have your own medical billing home business.

Typically working from home for an employer requires a level of trust that comes with a lot of experience in the field and working for this particular employer. You may see advertisements for home medical billing jobs or medical claims processing at home but they are usually thinly disguised attempts to make money for some overpriced business opportunity. So be wary of these ads – if it sounds too good to be true it probably is.

If you have worked for a practice as medical billing specialist and have a good relationship with the doctor or office manager, this would be a good opportunity to approach them about medical claims processing at home.

Operating a medical billing business requires training and knowledge to be successful. The financial success of a doctors practice and those they employ is dependent on a good medical billing specialist. And they aren’t going to turn this responsibility over to just anyone they don’t feel will improve their present situation. Being a successful medical billing business owner requires training in the field, the ability to produce results for your client, and convincing a doctor to entrust you with the billing.

In summary processing medical claims from home is viable. It takes the right situation or opportunity, training, and a good knowledge of medical billing. From my experience it requires self motivation and the ability to separate home from work, but it sure beats going into an office every day.

Recent Articles

Is it possible to work in Medical Billing or Coding at night instead of during the day?

Oct 23, 17 09:16 PM

How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I’m an

Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

Oct 23, 17 09:15 PM

Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

What is the CPT code for ‘Male Hormone Panel’

Oct 23, 17 08:57 PM

What is the CPT code for ‘Male Hormone Panel’ . testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We’ll post in hopes our Visitors

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.

Copyright 2017 All-Things-Medical-Billing.com

Claims processing software

Claims processing software


Medical Claims Processing, Apex EDI Billing Clearinghouse, claims processing software.#Claims #processing #software


Medical Claims Processing

Stop sending claims the old-fashioned way. We ll save you time and money!

Process your electronic claims with Apex EDI and get paid faster, 5-12 days.

OneTouch ® electronic claims delivery is fast, convenient, and affordable!

Our Clients are Big Fans

We deliver Wow! through caring.

This has been one of the best decisions I ever made. Our payments are arriving much faster than ever before and we are not having to do any duplicate filing.

John A. McCall Jr., OD

We have been very pleased with the service Apex has provided to our office. It has saved much time and hassle getting claims paid in a shorter time period.

Dr. M Kelly Soutas

I strongly recommend that all medical and dental providers and billing services consider using Apex EDI as an effective tool to reduce administration costs

I would like to take a moment and express my gratitude. Our transition to Apex has been the smoothest transition I have ever been involved with. From the moment

I couldn t be happier with the level of service that I have received; from the first day I felt I was in very capable hands. I look forward to the day I can pass on

By taking advantage of Apex we have cut our billing time down significantly, and payments from insurance companies are coming in a quick, concise, and

I just wanted to let you know we are seeing payments and the turnaround time is AMAZING! Apex is allowing us to collect so much faster than before, and

News Events

Medical billing is a complex task where many things can go wrong. It takes

Telemedicine is not a passing trend. It’s the future of healthcare, with

The U.S. recently faced back-to- back major hurricanes. Texas and Florida h

Thousands of practices use our products and services to increase productivity and improve patient care.

Apex EDI takes the headache out of processing medical claims, dental claims, optometry claims, and chiropractic claims. Our solutions simplify the claims delivery process. We offer OneTouch ® electronic claims processing, real-time eligibility verification, patient statements delivery, and electronic remittance advice (ERA) and tools that accelerate the patient payment collection process.

Claims processing software

Partners

Apex EDI has created the OneTouch ® solution to offer you an easier and less expensive way to process your insurance claims electronically and receive faster reimbursement.


Medical Claims Processing, Apex EDI Billing Clearinghouse, dental claims processing.#Dental #claims #processing


Medical Claims Processing

Stop sending claims the old-fashioned way. We ll save you time and money!

Process your electronic claims with Apex EDI and get paid faster, 5-12 days.

OneTouch ® electronic claims delivery is fast, convenient, and affordable!

Our Clients are Big Fans

We deliver Wow! through caring.

This has been one of the best decisions I ever made. Our payments are arriving much faster than ever before and we are not having to do any duplicate filing.

John A. McCall Jr., OD

We have been very pleased with the service Apex has provided to our office. It has saved much time and hassle getting claims paid in a shorter time period.

Dr. M Kelly Soutas

I strongly recommend that all medical and dental providers and billing services consider using Apex EDI as an effective tool to reduce administration costs

I would like to take a moment and express my gratitude. Our transition to Apex has been the smoothest transition I have ever been involved with. From the moment

I couldn t be happier with the level of service that I have received; from the first day I felt I was in very capable hands. I look forward to the day I can pass on

By taking advantage of Apex we have cut our billing time down significantly, and payments from insurance companies are coming in a quick, concise, and

I just wanted to let you know we are seeing payments and the turnaround time is AMAZING! Apex is allowing us to collect so much faster than before, and

News Events

Medical billing is a complex task where many things can go wrong. It takes

Telemedicine is not a passing trend. It’s the future of healthcare, with

The U.S. recently faced back-to- back major hurricanes. Texas and Florida h

Thousands of practices use our products and services to increase productivity and improve patient care.

Apex EDI takes the headache out of processing medical claims, dental claims, optometry claims, and chiropractic claims. Our solutions simplify the claims delivery process. We offer OneTouch ® electronic claims processing, real-time eligibility verification, patient statements delivery, and electronic remittance advice (ERA) and tools that accelerate the patient payment collection process.

Dental claims processing

Partners

Apex EDI has created the OneTouch ® solution to offer you an easier and less expensive way to process your insurance claims electronically and receive faster reimbursement.