1
After a claim is submitted, the payor will either reject the claim if it determines criteria are missing or accept the claim for review.
2
When a patient initially requests an appointment, the registration process begins during which patient insurance and demographic information are collected by your scheduler.
3
Upon successfully passing this scrubbing process, the claim is submitted to the appropriate insurance payor for review.
4
The nursing team completes vital signs and the rooming process, inputting information that will help determine the level of service (LOS) provided and to be charged to the patient.
5
Helps UNC Health Care catch errors prior to a claim being sent to an insurer.
6
This information is used to check real-time eligibility (RTE) to ensure that the service requested will be covered (i.e. paid for) by the patient’s insurance carrier.
7
Closing the encounter consolidates this information onto a claim that can be submitted for reimbursement.
8
Claims that are identified as this are submitted to the appropriate payor
9
Document that provides the provider and the patient with information on the claim decision.
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