Question

Describe each basic step of the insurance claim life cycle? 18 steps

Answer 1

Answer:

Step#1 Patient appointment and preregistration

Before addressing a new patient an primary appointment, it is necessary to complete a New Patient Intake Interview. This enables the office staff to collect introductory data to ensure that the patient has called the appropriate office for an appointment and to review on the patient's insurance eligibility and benefit status.  

Step#2 Insurance information  

The patient's eligibility for the insurance policy and the advantages of the plan need to be confirmed and filtered before the patient is given the initial appointment. How this check is completed will depend on the healthcare provider state as either a primary care physician or healthcare specialist.

Step#3 Notice of privacy

While running the entire process, the doctor and health care officers have to make sure about the patient's privacy and also focus on that the patients confidential information id not leaked or misused. This responsibility of the doctor and nurse deadline the patient.

Step#4 Insurance ID card photocopied

The purpose of this step is to get the insurance identity card copied to maintain a record in the patience chart, which can be helpful for either part in the future. There are a couple copies photocopied so that if one gets lost, there should be an extra pair.  

Step#5 Patient's signature requirements

Until and unless a form/document is not signed, it display no authenticity. So in order to file a claim, one must fulfills all the requirements along with the signature one as it shows the consent of the patient undergoing any treatment.  

Step#6 Assignments of benefits

Assignments of benefits is an agreement by which a patient demands that their health benefits amounts be made directly to a nominated person or facility, such as a physician or hospital. While filing an insurance claim, this agreement can act in the benefit of the patient.

Step#7 Patient's financial account

The patient's financial account is the financial record reference document utilized by health care providers and other personnel to enter the patient's treated diagnoses and the services given to the patient during the current encounter. The least information entered on the format is the date, patient's name, and balance due on the account.

Step#8 Medical services performed and encounter form completed  

The encounter form (also called as the charge slip, routing form, or super bill) is the account which shows what treatment patient has gone through and received. Along with this this step also states the performance of the service/treatment given to the patient.  

Step#9 Patient's financial data posted and patient checkout

In this step as the treatment is completed, the patient prepare himself/herself for the leaving the hospital and all the financial data including the expenses, services used are posted so that the patient can later on claim the amount of money spent on the treatment.

Step#10 Insurance claims preparation

Once the patient is back home, he/she plans for filling a claim in order to reimburse the money used on the treatment. The purpose of this facility is to help the individual deal with all the financial obstacles related to health.

Step#11 CMS-1500(02-12) paper claim form submitted

This is the paper claim form needed by all federal payers and private payers alike. Even though today maximum claims are presented electronically, there are still times when a paper claim is demanded or required. And there are a handful of little insurance companies who still only accept the paper.  

Step#12 Electronic (HIPPAX12837) claims transmitted

An “electronic claim” is a paperless patient claim form produced by computer software that is forwarded electronically over telephone or computer correlated to a health insurer or other third-party payer (payer) for processing and payment.  

Step#13 Provider's signature

As the patience/filler's signature is mandatory on the claim form, likewise the provider's signature is also important on the claim or else the amount will not be granted and claim would get stuck. So in order to get the claim sanctioned it is essential to get the signature of the authorized person.