Billing and Claims Cycle

Quick Claim Cycle Process

Charges reconciled after the provider treats the patient

Documentation or medical records are verified

Coding edits and rules apply

Coding completes

The billing system scrubber is the first stop

The clearinghouse is next to provide claims a second scrub

Finally claims are run through another series of edits and rules in the payer’s system

The outcome or status could be a claim that is paid, partially paid, or denied

Payers will adjudicate clean claims on the first submission