Medical Claims Processing

Kana iwe uchida kuva chiremba wezvechiremba, heino chidzidzo pamusoro pehutano hwekugadzirisa kudai.

Chidzidzo Zvinangwa

Chinangwa 1: Kubhadhara Kuda Kwemagetsi

• Tsanangurai 837-P
• Tsanangurai 837-ini
• Zivai zvikamu zveChipatimendi Chekuita
• Tsanangura nzvimbo yekuchenesa

Chinangwa 2: Kubhadhara Mapepa Anofanirwa

• Ziva mapepa akasiyana-siyana ekubhadhara mapepa
• Pedzisa fomu yeCMS-1500 kana UB-04
• Kuzviisa kwakakodzera kwepa pepanhau kudai

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Kubhadhara Electronic Claims

Medicare , Medicaid , uye mazhinji emamwe makambani einishuwarenzi anobvuma zvinodhaka zvemagetsi seyo nzira yekutanga yekubhadhara. Iko shanduro yemagetsi yeCMS-1500 inonzi 837-P, iyo P ichimiririra maitiro ekugadzira. Iko yekombiyuta yeBH-04 inonzi 837-Ini, ini ndinomirira maitiro ekugadzirisa.

Kuti ubudirire kuisa zvinodhaka zvemakemikari, mushonga wezvechiremba unofanirwa kunzwisisa zvinoshandiswa kune zvakasiyana-siyana zvevaiti vezvekuchengetedza zvikwereti vanoisa zvirevo. Nhamba yega yega 837 kutumira kunotumira faira data kune inshuwarisi inonzi Transaction Set. The Transaction Set yakavhuniwa muzvikamu:

1. Transaction Header
2. Kubhadhara Mutengesi Detail
3. Dhairirano
4. Patient Detail
5. Claim Detail
6. Transaction Trailer

Kunyange zvazvo zvisingakoshi kuti mabhizimisi anzwisise kutengesa zvigadzirwa, zvakakosha kuti chimwe nechimwe chinopinda muhurongwa hwekubhadhara chinotevera mitemo yakakodzera yekudzivirira zvikanganiso nekutsvaga kurasikirwa.

A refinghouse is a company that will accept all your claims and electronically forward them to the insurer insurer for processing. Ivo vakagadziridza munzvimbo kuti vaongorore zvikanganiso mubato renyu kuti vabatsire kudzivisa kunonoka mukubhadhara.

Kubatsira kukuru kwekubhadhara magetsi kana iwe uchishandisa chekuchenesa kana iwe kutora bhiri ndeyokuti iwe uchakurumidza kushandiswa kwekutaura kwako. Pepa yekubhadhara kunogona kutora mazuva makumi mashanu ekugadziriswa apo kubhadhara komagetsi kunotora mazuva 7 kusvika ku21.

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Billing Paper Claims

Pepa yekubhadhara haisi yekutanga kusarudza zvikwereti zvekurapa asi dzimwe nguva basa rakafanira. Zvechokwadi, magetsi ekutsvaga maitiro ari nyore uye anokurumidza kufananidzwa nehuwandu hwebhuku rekubhadhara pepa.

Pose papepa yekubhadhara inoshandiswa, chengeta izvi mupfungwa:

• Sarudza fomu yekubhadhara yakajeka: Zvakakosha kunzwisisa uye kushandisa chimiro chekutsvaga chekurapa. Sarudza pakati peCMS-1500 uye maBB-04 mafomu ekutsvaga.
• Iva nechokwadi chekuti mafaira acho akarurama: Vamwe vatengi vanobvuma mifananidzo yakatsva-ne-nyeredzi yezvokurapa kwezvokurapa asi zvakanakisisa ndechokuisa mutsara wekutanga-uye-white version. Zvichienderana nezvinobhadhara, kana chimiro chokutanga chekutsvaga chisina kushandiswa, kudai hakugoni kuisa muitiro yavo zvakanaka kusika kunonoka kana kuramba mukubhadhara.
• Isa data yakarurama pane imwe nzvimbo yakakodzera: Tarisai nemubhadhari wega wega wega kuti uone kuti chii chinodiwa. Iva nechokwadi chokuti yese data yakapinda nenzira yakarurama uye yakarurama muminda yakarurama.
• Ivai nemagwaro akakodzera: Dzimwe nguva kubhadhara mapepa kunoda mapairi akakodzera kuti atumire nefomu yekubvunza.

Zvimwe

Chidzidzo 4: Medicare, Medicaid, uye Mimwe Mibairo

Kunzwisisa zvidzidzo zveMedare, Medicaid, Tricare, uye Bhizinesi yebhadhiji vanobhadhara