NABH Accreditation
Provider Billing
The first step in the health claim payment reconciliation process is to review the billing information submitted by the healthcare provider. This includes the diagnosis codes, treatment codes, dates of service, and the cost of the services rendered. It is important to ensure that the billing information is accurate and matches the services provided.
Payer Payment
The second major point to review is the payment made by the health insurance payer. The payer may pay all or a portion of the billed amount, depending on the insurance policy and the contract between the payer and the provider. The payment should be compared against the billing information to ensure that it is accurate and covers the services provided.
Patient Responsibility
The third major point to review is the patient’s responsibility for payment. This may include deductibles, co-pays, and other out-of-pocket expenses. It is important to ensure that the patient’s responsibility has been accurately calculated and included in the reconciliation process.