subject: Basics About Medical Insurance Claims [print this page] Basics About Medical Insurance Claims
Many insurance companies out there receive hundreds and hundreds of medical claims almost on a daily basis from medical billers. These medical claims are usually itemized and all the charges are always listed separate from each other ready to be processed. Often patients have to submit medical claims to their insurance company, but they do not have to include in their claim all the pertinent personal details.
Medical insurance claims are generally pretty standard forms which are used by health billers. This type of forms is usually submitted to various insurance companies by medical personal which are mainly seeking payment for various health services. Upon receipt, this type of forms is usually being processed by a department which deals specifically with medical insurer claims. Each billed charge has to be checked so it can be determined if is payable or not. Those charges which are then approved for payment will then be paid to the provider in a form of a rate which was agreed before.
Generally, there are two different types of medical insurance claims. Professional charges are usually being billed on a specific form, the HCFA 1500 claim form. These are professional claims which will include charges for various services rendered by a certain physician. Certain services which are usually performed during an office visit, like for instance, a blood work or an x-ray, are usually billed as separate charges from the actual visit.
There are also facility claims which are also known as UB92 forms and which are generally used for various charges incurred by a medical facility where those actual services are being performed. Facility charges will also always include separate costs for various things, like for instance, emergency room visits or various surgeries.
These were some basic aspects about medical insurance claims that you should have an idea about if you will ever be interested in medical claims.
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