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Chapter 8
Claim Management
This chapter explains briefly how to manage claims within the Claim Management
window and includes creating, editing, printing/reprinting, and listing claims, as well as
changing claim status.
The Claim Manager’s Job
To help you better understand the function of claim management, let’s use a shipping
analogy (see also Appendix D, page 161). Whereas Cases are containers filled with
claims for specific diagnoses, claim management is the process by which the cases are
checked, sorted and delivered. In other words, claim management is the process of
making sure all shipments are correct, ready to be sent and shipped to the right
companies (insurance carriers).
The Claim Manager (the person performing claim management) checks the claims,
makes sure the boxes are properly marked, and sends them on their way. She
determines whether the shipment goes by truck (paper claims) or by air (electronic
claims). When a box is returned (rejected claim), the Claim Manager makes whatever
changes are necessary (with help from the EOB or Audit/Edit Report) and ships the box
again (resubmits the claim).
Someone else sees and treats the patients. Another person enters data from the superbill
to begin the billing process. Once all the data has been entered, it must go through the
Claim Manager’s office before being sent to an insurance carrier.
The Claim Manager focuses on three principal areas, not necessarily sequential: Review,
batch, and final review.
Chapter 8: Claim Management
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