The Process of Medical Billing Insurance Claims


The the process of medical billing insurance claims starts with the healthcare provider treating a patient and  then sending a bill of services offered to a health insurance company. The the insurance company then assesses the claims based on some factors to determine what claims to cater for if there is any. There are some technical protocols and industry standards that must be met for the efficient and accurate delivery of insurance claims between the payer and medical practice.

Medical billing specialists use some claims adjudication software to take the patient data, prepare insurance claims, and hand them over to the appropriate party.

There are two methods used to deliver insurance claims to the payer: manual and electronic. Majority of insurance firms and healthcare providers prefer the use of the electronic request system. This the method is more accurate, more inexpensive and fast to process.

Electronic Claims Filing

There are some technologies that have been introduced into the system so as to expedite application processing and increase accuracy. The techniques include the following


Some healthcare providers use software to enter information into the UB-04 electrically and CMS-1500 documents. The fill and print software prevents the possibility for unreadable information. The software also may include certain tools that check for errors in the documents. While these tools reduce the errors in the reports, they are not completely accurate, therefore the medical biller should be diligent when filing out the forms using the chiropractic claims software.

OCR (Medical Character Recognition)

OCR equipment scan official documents, electronically isolating and recording information provided in the different fields, and auto-filling that information into other documents whenever necessary. The OCR technology assists in making the hardcopy claim processing much more efficient, but it is important to have human oversight to ensure accuracy. Learn about medical claims at

Benefits of using the Electronic Medical Claim Bill Service

It is possible to integrate information between the hospital system and the insurer system.

The time of insurance reimbursement is minimized.

The the system allows saving of more patient related electronic data than when using the manual records.

It allows for customized patient medical and personal data that includes their medical history, tests, diagnosis, insurance policy and details of the insurer, and other relevant information.

Fewer errors  in application when using the electronic medical billing claim over the manual billing.

There are numerous medical billing clearinghouses that use electronic means to file medical claims. Clearinghouses are a third party service that acts as a link between the health care provider and the insurer. What the clearinghouse does receive claims from the health care provider, remove any errors in them, and put it in the HIPAA and insurance standards format, and then send it to the appropriate parties.

The clearinghouses play an important role because hospitals have to send high-quality insurance claims each day to different insurance providers. Each of the insurance companies have their submission regulations and the medical facility may not know of this hence the need for clearinghouses.


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