The cycle
- Pre-authorization: before costly procedures, submit a pre-auth for the insured patient and record the approval number.
- Claim: after the visit, the covered services become a claim to the payer with the agreed fee schedule prices.
- Remittance: when the payer pays, record the remittance and match it to claims — differences become adjustments you can track.
Fee schedules
Each payer can have its own price list, so the claim always uses contract prices — not your retail prices.
Tip
Track rejected claims by reason — patterns there usually mean a missing approval or a coding mistake you can fix at the front desk.
#insurance#claims#remittance
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