Claim scrubbing, also known as claims editing or claims validation, is a process in medical billing that involves reviewing and validating healthcare claims before they are submitted to insurance companies or third-party payers for reimbursement. The purpose of claim scrubbing is to identify and resolve errors, inaccuracies, or missing information in the claims to increase […]
Category: Claims
What is Cost Sharing in Health Insurance?
Cost sharing in health insurance refers to the portion of healthcare costs that policyholders are responsible for paying out of their own pockets. It is a way to distribute the financial burden of healthcare expenses between the insurance company and the insured individual. Cost sharing typically includes various types of payments, such as deductibles, copayments, […]
What does Claims adjudication mean in medical billing?
Claims adjudication is the process by which insurance companies review, evaluate, and make a determination on healthcare claims submitted by healthcare providers. It involves the examination of the claim for accuracy, completeness, medical necessity, and compliance with the insurance policy’s terms and conditions. The goal of claims adjudication is to determine the appropriate payment or […]
What is Clean Claim in medical billing?
In medical billing, a clean claim refers to a healthcare claim that is accurately and completely filled out without any errors, discrepancies, or missing information. It is a claim that meets all the requirements and guidelines of the insurance payer, making it ready for processing and payment without the need for further investigation or clarification. […]
What is Coordination of Benefits (COB) in Medical Billing?
Coordination of Benefits (COB) is a process used in medical billing to determine the primary and secondary insurance coverage for an individual who has multiple health insurance plans. When a person is covered by more than one insurance plan, COB ensures that the total benefits paid by all the plans do not exceed the actual […]
What is Electronic Claims Submission in Medical Billing?
Electronic claims submission in medical billing refers to the process of electronically transmitting healthcare claims from healthcare providers to insurance companies or payers for reimbursement. It involves the electronic exchange of claim data and supporting documentation, replacing traditional paper-based claim submission methods. Here are some key points about electronic claims submission in medical billing: Efficiency […]