Claim submission process in Medical Billing

Claim submission process in medical billing is one of the important steps in medical billing process. It decides the amount, the health care provider will receive after the insurance company clear the dues. The health care providers reimbursement depends on proper submission of medical bills to the insurance company. If claim submission process is followed correctly, health care provider will receive the reimbursement in time. Otherwise claim may denied or rejected.

Claim submission:

The of Claim submission begins after the medical coding and processing of claim. Nowadays claims are submitted by Electronic Data Transfer (EDI).

For proper claim submission following steps must be followed.

  • Electronic Health Record (HER) software is used for electronic claims medical billing to check the relevant information. It checks the codes entry and all relevant fields are properly filled.
  • It requires patient information, patient demographic information, including personal and contact information, patient referral or appointment scheduling, patient health history, Insurance eligibility verification.
  • Patients are informed about services and procedures not covered in the insurance plan and about copayments.
  • Patients medical report is sent to the medical coder. Medical coder will dig out relevant billable information from the records and assign the correct billing codes ICD-10 codes for diagnosis and CPT and HCPCS codes for services / procedures performed.
  • Superbill will be prepared. All the charges will be entered into practice management software beside the expenses bear by the patient at the period of service. The superbill will contain patients’ information, health care providers information, medical codes and all related information. Supportive documents may be added by the health care provider.
  • Next step is claim scrubbing. In this biller will check the codes and validate that all the data entered is correct and all the services added are billable.
  • Claims are presented on a specific form. For hospital practices CMS 1450 or UB-04 and for submitting medical bills to Medicare CMS 1500 is used.
  • Once the claim is received, the insurance company will determine its authenticity and rule out how much the company will reimburse the provider. Insurance company may accept or reject a claim depending on all the information. The insurance company will send Electronic Remittance Advice (ERA) back to the provider. This report is called adjudication. It will also include explanation of why certain procedures are not covered. Besides this it also provides the reason of denied and rejected claim.
  • Patient statement will include the payment which has to be paid by the patient, which is not covered by the insurance company

Benefits by our Claims Submission Team at Ibex

Ibex Medical Billing claims submission team offers:

  • Claim denials are avoided by addressing issues beforehand.
  • Accounts Receivable is improved due to reduced number of denied claims.  
  • Accomplish greater and faster reimbursement

For any additional regarding Claim submission process in medical billing visit