Claims Processing or Billing Control Point
The claims processing or billing control point includes filing claims and working the audit trails (first line payer rejection). Claims can be filed on hardcopy forms or they can be transmitted electronically. In order to maximize efficiency at this control point, maximum automation
and immediate resolution of claim edits and baseline or audit trail rejections is required. Regardless of the filing method, internal controls are critical to ensure claims are actually filed.
The automation of claim production results in significant savings and improved cash flow. Lower costs are achieved by reduced human resource requirements and administrative costs (postage / paper). In addition, major payers process electronic files in a more timely manner. This results in immediate feedback regarding baseline rejections (audit trail reports), lower accounts receivable, and improved cash flow. Paper claims, on the other hand, are necessary in specific situations. Many claims, such as those for workers compensation, must be filed with documentation and unfortuantely, at this point in time, many commercial payers cannot accept electronic files.
|
|
