What is the process of sorting claims upon submission to collect and verify information about the patient and provider called?

What is the process of sorting claims upon submission to collect and verify information about the patient and provider called?

• A. Authorization
• B. Adjudication
• C. Processing
• D. Submission

Answer: (C)

The process of sorting claims upon submission to collect and verify information about the patient and provider is known as processing. During this phase, claims are reviewed to ensure accuracy and completeness of the data submitted, including patient eligibility, coverage details, and provider information. This step is crucial as it helps to identify any discrepancies or missing information before the claims move on to further stages such as adjudication. Adjudication refers specifically to the determination of reimbursement based on the information provided in the claim. Authorization is the process of obtaining approval from a payer for specific services before they are rendered, ensuring that they are covered by the insurance plan. Submission refers to the initial act of sending claims to the payer for review without the detailed processing and verification that occurs thereafter. Understanding these distinctions helps clarify why processing is the key step in the claims lifecycle that involves sorting and verifying information prior to adjudication.

The process of sorting claims upon submission to collect and verify information about the patient and provider is known as processing. During this phase, claims are reviewed to ensure accuracy and completeness of the data submitted, including patient eligibility, coverage details, and provider information. This step is crucial as it helps to identify any discrepancies or missing information before the claims move on to further stages such as adjudication.

Adjudication refers specifically to the determination of reimbursement based on the information provided in the claim. Authorization is the process of obtaining approval from a payer for specific services before they are rendered, ensuring that they are covered by the insurance plan. Submission refers to the initial act of sending claims to the payer for review without the detailed processing and verification that occurs thereafter. Understanding these distinctions helps clarify why processing is the key step in the claims lifecycle that involves sorting and verifying information prior to adjudication.