Claims Processing (Resource 199)

A properly completed claim (whether paper or electronic) is a critical component of the reimbursement process. A clean claim is vital to the processing and payment of your claims. The "cleaner" the claim, the faster you will receive payment. It is the responsibility of the provider to understand what is needed and required by the carrier, then provide that information in the specified manner and time frame.

You need to understand the following concepts:

  • Claim Followup Procedures
  • Denial Management
  • Appeals Process

See also Chapter 1-Insurance and Reimbursement in the Behavioral Health DeskBook for important claims processing information..

Links:

Articles:

Forms (Current Behavioral Health DeskBook Users)

  • Voluntary Refund Form
  • Prompt Pay Letter