Claim creation & submission

What is a Medical Claim?

A medical claim refers to a bill that a medical service provider sends to an insurance company to make it pay for a patient’s medical treatment and services.

Various codes, specifying different medical services, are provided to a patient. These codes are entered into the medical claim so that payment can be demanded accordingly. The services provided to the patient can be of many types, such as diagnosis, treatment, medical devices, medicines, and medical transportation.

The codes of required services are listed in the medical claim. Insurance providers take a detailed look at the claim and the codes in it and pay accordingly.

Claim Creation

Our specialists prepare a specific file for each claim, which contains all the information related to a patient and his or her treatment. These details cover all the stages of the patient’s treatment.

The first part of this file is prepared as a claim header, which contains the most important information about the patient, such as name, gender, date of birth, address, and others. Plus, the claim header includes which doctor or institution is treating the patient, the diagnosis, whether the patient will be provided inpatient service, patient insurance company details, and so on.

Other details are included in the second part of the claim file. Those details are usually about the inpatient services or include information related to the secondary diagnosis.

The information can be of various types, but the most important one is about when the medical services were provided to the patient, what the nature of the diagnosis is, and what the detailed codes of the medical services provided to the patient are. Also, the information of the doctor providing the medical services is included in this section.

Claim Clearance

BillMyMed’s experts review the medical claim thoroughly after preparing it and send it for clearance once they make sure there is no error in it. Claim clearance is the halfway point between the claim submission and the payment by the insurance provider.

The clearinghouse examines the claim, and once satisfied, it sends the claim to the relevant insurance provider.

If the claim is incomplete, the formatting is incorrect, or the codes are incorrect, the claim may get rejected, or it may be returned for corrections, which delays the process of payment.

To avoid such a situation, our experts make sure that the claim is accurately prepared so that there will be no problem with its clearance.

Claim Submission

BillMyMed ensures that the claim is error-free. This is why our claims are successfully passed through the clearance stage and then forwarded to the paying insurance company.

It’s because of our expertise and special care that all the steps from claim preparation to submission are perfectly completed on time. When these claims are sent to the insurance company, they are accepted.

The unmatched success of our claims proves how excellent our services are. At the stage of adjudication, two things are considered:

  1. Whether or not the claim is valid.
  2. The accuracy of the payment claimed.

Since our team takes care of preparing the claim with no errors, our claims have 99% of acceptance rate.

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