Enter the Patient’s Information
New patients provide age, insurance, and background info. For return visits, use recent records to simplify updates.
Check the Patient’s Insurance
Verify insurance by calling the number on the patient's card. Confirm coverage, benefits, deductibles, and co-payments.
Making of Superbills
For repeat visits, update records, show insurance and ID, and pay co-pay. Coders create a superbill with all visit details.
Generation of Claims
The medical assistant uses the superbill to prepare and submit a claim. The biller ensures it meets payer and HIPAA standards.
Filing of Claims
Once verified, submit the claim electronically to a clearinghouse, except for high-volume payers like Medicaid, who accept direct claims.
Monitor Claim Adjudication
Claims go through adjudication to determine legitimacy and reimbursement. Accepted claims are paid; denied claims can be corrected.
The Making of Patient Statements
After claim processing, unpaid charges are billed to the patient, detailing costs, insurance payments, and remaining balance.
Follow Up With the Payment
After claim approval, seek payment from the payer. Track accounts receivable to manage overdue claims and ensure timely follow-up.