Practices To Be Followed In Medical Claim Processing Services

Successfully managing and handling bulk insurance claims is a tiresome and risk-involving activity. On the contrary, if you are striving to maximize the ROI, outsourcing the crucial medical claim processing services is a reliable choice.

medical claim processing services

Often, the insurers face difficulty with the claim operations because of the multiple variations in the processing stages. The healthcare firms are seeking an efficient way of reducing the medical claim processing and outsourcing the requirement to a professional medical claim processing service provider can simplify your challenges.

Generally, the healthcare sector faces ample challenges during medical claim processing because of the claim denials and delay.

Here’s a checklist of the practices to be followed in the medical claim processing service!

Electronic Claim Submission

The online medical claim processing will minimize the paperwork and therefore, create a lot of free physical space. It will consume less time in dealing with the claim submission. Generally, it has been noted that electronic submission of claims is far effective than paper-based claims. One of the prime benefits of practicing electronic claim submission is that you can view the claim status online, streamline the profile, along with executing a verification on the member eligibility. The processing of electronic claim submission largely takes up to one or two weeks and it will improve the cash flow. It will also reduce claim denials and cost reduction.

No Irrelevant Information

Mostly, the delay in medical claim processing occurs due to the presence of numerous errors. The causes could be the irrelevancy in patient names, insurance ID, date of birth, etc. And once the claims are rejected due to inaccuracy, the errors need to be detected and rectified on-time. Though checking for inaccuracies is a time-consuming process, the complete procedure isn’t a complicated one for the medical claim processing companies. Ensure to analyze the original documents, in case any errors pop up. The health insurance claim processing service providers will keep the data up-to-date that will minimize the errors in the phase of processing.

Collection of Co-Payments and Patient Balance

There are instances wherein the patients walk out without making any payment (in cases where payments are not collected before the treatment initiation). But make sure to collect the co-payments. The account of patients should be reviewed from time-to-time for making sure that the prior balance gets collected. It is of importance to collect the financial responsibility statement of the patient before proceeding with the treatment. Before adding any extra charges, the prior balance should be checked upon.

Patient Invoices

You should ensure that the patient invoices are sent within the posting of ‘explanation of benefits’ is proceeded. The patient invoices comprise the name of service undertaken, date of service, gathered payment, amount of insurance reimbursement received, and so on. The invoice should be simple, precise, and clarity-based, thereby, easing the process of understanding the invoice. Basically, the invoice should be patient-friendly.


Analytic can be utilized for performance optimization and it will help you adhere to the advanced regulations. The analytic details will highlight the areas that require some improvements and it will contribute to the enhancement of your services. The top healthcare claim processing companies will assist you in finding the error source and rectify the challenges accordingly. This will boost the management of medical claim processing in an efficient way.

MediBilling Experts has been recognized as one among the best medical billing service provider, rendering an equal prominence to the customer’s need of managing medical claim processing services. Following the above-mentioned practices to handle the medical claim processing can ease your business functioning, especially in the long run.

Post by Jessica Dawson

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