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Medical Claims Processing: Increasing Your Awareness and Understanding The health care system is a multi-billion industry, and millions of people rely on specialized professionals whose job is to ensure that the operations of medical care facilities, pharmaceutical companies, pharmacies and medical equipment manufacturers are following the law and policies governing people’s health. One of the standard system of balance and check is through medical claims process. Medical claims processing deals with the interaction of health care providers and medical insurance agencies. In order to understand medical billing and coding, it is important to discuss the relationship between health care providers, policy holders and health insurance companies first. Health care providers are private clinics, hospitals, pharmacies, dental clinics, nursing homes, assisted living facility, in-home caretakers and chiropractor, where a patient receives and is billed for health products and services. On the other hand, insurance companies are the ones providing medical subsidies for qualified patients or policy holders. Insurance policies varies from one company to another, and many people have different insurance coverage obtained privately, from an employer or from the government. Insurance companies operate under the same business operation wherein a policy holder pays a certain amount of money monthly or annually to the insurance agency, which is termed as premium. Depending on the terms of coverage, insurance companies would pay in full or partially the medical expenses involved in a policy holder’s hospitalization, a medical operation or medical procedure such as diagnostics and medicines and other medical supplies used. In the health care system, a patient or a policy holder is someone who purchase a health insurance, such as a young adult for example, finding a basic insurance coverage to pay all medical expenses more than the deductible, wherein the amount is pre-arranged and should be paid before the health insurance coverage sets in. The medical claims process through the initiation of a policy holder, wherein health care products and services are availed from a health care provider that may include consultation, laboratory or any diagnostic procedure, surgery or hospitalization. The patient or the policy holder is financially responsible to pay the deductible, for which the amount of money that he agrees to pay before the insurance coverage begins, after receiving the health care service. The transaction between the policy holder and the health care provider is complete once the policy holder have supplied and verified all of the information needed for his medical claim or dental claim processing. And this is when the transaction between the insurance company and the health care provider starts. The health care provider ensures that all medical records of medical services are included in a medical claim, and medical coders and billers are the ones who are responsible for creating this medical records, and send these claims to the policy holder’s insurance company. The insurance company will review the medical claim and will either accept or decline the claim basing on some factors.The 10 Best Resources For Resources