Simplexmed can assist you in the compilation, calculation, submission and settlement of your insurance claim with insurance companies and medical payers.
Not only does our assistance optimize your entitlement, but it also reduces the time claims normally demand; allowing you to focus on what you do best, running your practice and maintaining relationships with patients.
Healthcare providers prepare insurance claims using information provided in the patient’s bill. Occasionally, the claim is prepared manually and sent by mail. In most cases, the claim is sent electronically (having either been prepared using claim software or scanned from a hard copy) to a clearinghouse. The clearinghouse checks the claim for errors, formats it according to HIPAA and insurance guidelines, then transmits it to the appropriate payer, while also sending a report back to the healthcare provider.
After the claim has been evaluated, the insurer must provide both the patient and healthcare provider with an Explanation of Benefits (EOB). The EOB breaks down the adjudication process, showing the dates of service, procedures and charges, patient financial responsibility, and the amount paid to the healthcare provider. At this point, the health insurer sends payment to the healthcare provider, usually in the form of an electronic fund transfer.