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How Medical Claims Processing Works Medical billing entails a process whereby one party, the healthcare provider, forwards documents to the next party, the insurance company, seeking payment for the medical services offered to one of their clients. Medical billing is conducted on all health insurance whether they are government sponsored programs or private companies. Medical coding includes all the details regarding the diagnosis and treatment of the patient. Health insurance has allowed many people to gain access to affordable healthcare in the United States. They have had a positive impact on the way healthcare is provided in the country. Traditionally, the process of filing medical billing was entirely done on paper. It included the use of postal address and fax machines to handle the entire process. Before a resolution was reached by both parties, it took a long time. However, with recent changes in technology, this process has been made electronic. Manual work of filing medical billing has been replaced by the medical claims processing software. The EDI billing as they are known, have managed to make the entire process fast and has allowed for both parties to reach an agreement fast. The new technology can handle a huge number of claim filing at once. It has allowed room for instant feedback and real-time update of data. The process has also opened doors of opportunities for many people and has resulted in the formation of big companies. Software and technology companies realized the potential of medical claims processing and have done their utmost best to provide hospitals and insurance companies with the best solution. The claims processing software has also improved the channel of communication between the vendor (health insurance) and the subcontractor (hospitals).
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As far as business opportunities are concerned, medical billing clearinghouse has been on the rise. These clearinghouses act as an intermediary whereas they help the hospital to submit the claim to the insurance company. Clearinghouses also conduct claim scrubbing which is checking for errors related to the claim. They also check to see if the claim is compatible with the software of the insurance provider.
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The process of medical billing may take a long time to complete and it is complicated even further if the payer and the provider are enrolled in two different clearing houses. This means that the claim will be forwarded from one clearinghouse to the next and the process might go to and fro. The process means that there are higher chances of the claim getting lost and falling into the wrong hands. Healthcare providers are encouraged to always ask where the claim will go after it leaves the clearinghouse to avoid any mix-up and loss of data.