Introducing healthcare claims processing
Claims are at the heart of how money is exchanged between healthcare payors and the provider’s ecosystem. A claim decides the amount that a provider gets for the healthcare services they perform. There are multiple stages in the life cycle of a claim from the time it is submitted, adjudicated, and disbursed. This process is known as claims processing, and the associated workflow is known as a claims processing workflow.
Before we look into the details of claims processing stages, it is important to understand what a claim typically contains. The claim has some basic information about the patient in question. It has the details of the healthcare services that the patient received and the charges for those services as quoted by the provider. If the payor agrees with the charges, it pays the amount to the provider. Most of these claims are paid out by the payor directly to the provider, but there are some instances when a patient needs...
