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Claims Processing: How Claims Are Authenticated

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Payment for medical services can be a complicated process due to the involvement of a third party (insurance) with interests of its own. You may already know what the process of submitting a medical claim is like, but what happens after the claim leaves your desk and is sent on to the insurer? Here, we’ll discuss the standards set forth by medicare for authenticating medical claims, standards that are typically followed by other insurers.

What has to happen before a medical claim can be processed?

Before a medical claim can be processed, it must first be authenticated through a rigorous process of signature analysis. This process is important for physicians and medical practices to understand so that they can submit authentication materials properly. What does an insurer look for in claim authentication?

First of all, any service that is provided or ordered for a patient must be signed for by the ordering practitioner, and this signature must be handwritten, electronic, or in the case of physical disability, stamped. Electronic signatures must come from a system that is protected against modification and signatures used to prescribe medication must be submitted through a qualified e-prescribing system. The signing physician and practice are responsible for the authenticity of the signature.

All signatures must be legible so they can be identified by those reviewing them. Failure to provide a signature or the presence of an illegible signature will result in the medical practice being assessed an error. If there is a failure to sign, the medical practice may submit an attestation statement from the author of the medical record, or progress notes showing intent to order tests.

If a signature is illegible, submitting a signature log may resolve the issue. A signature log is a document that contains physician names with their corresponding unique signatures, and can be used to establish ownership of a signature. Submitting a signature log initially may help reduce delays going forward.

It is very important that all medical claims can be accurately authenticated to avoid unnecessary services and overpayments. While this process may seem lengthy, it protects the patient, physician, practice, and insurer.

Filing medical claims can be a stressful process that weighs heavily on the staff of any medical practice. It doesn’t have to be, though. Simplify your medical billing and avoid costly, time-consuming errors by hiring a clearinghouse like Apex EDI. Apex EDI has everything you need to effectively file medical, vision, dental, and chiropractic claims without putting such a strain on your practice. Request a demo today, and see what a difference the right clearinghouse can make.



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