Medical Claims Processing Workflow Template

OpsDog Medical Claims Processing Workflow - Preview Image

Overview: Medical Claims Processing Workflow Template

This workflow template illustrates the process by which medical insurance claims are received, processed and approved/denied. Purchase and download this template in PDF, Visio (VSD) and PowerPoint formats. You can customize it to fit your own organization, or simply use it to better understand the Medical Claims Processing.

Download a Free Sample of this Workflow Template


Process Details and FAQ: Medical Claims Processing

What is Medical Claims Processing?

Medical Claims Processing involves receiving, processing and approving/denial of medical insurance claims. This process includes a case review (policy, type of injury, treatment of injuries, etc.), assessment of medical coverage, adjustments, payment request (if approved) and client notification (medical management reports, etc.). Though a number of people involved and the length of this process may be long, it is generally good practice to keep customers up to date.


Which KPIs, or metrics, are typically used to measure this process?

The following metrics may be used to measure Medical Claims Processing:



Which employees and/or departments are involved in this process?

The following parties are typically involved in Medical Claims Processing:


  • Claims Manager
  • Medical Claims Adjustor
  • Medical Claims Processor

What is the purpose of these workflow templates?

Broken business processes pervade companies, large and small. Manual workarounds, downtime, errors and other waste is thought of as "the cost of doing business." Use our workflow templates as a starting point to document your own processes. Customize them to fit your business and add "call outs" for improvement opportunities.


How are these workflow templates created?

These workflow templates are the product of over 20 years of hands-on management consulting experience, as well as research performed by the OpsDog team. All of our workflows are mapped using the BPMN 2.0 specification.


How do I download a workflow template?

Simply click the "add to cart" button and follow the process to purchase and download this workflow template. You can use any major credit card, or a PayPal account, to pay. After you have completed the purchase, you will receive a link to immediately download the workflow template in PDF, Visio (VSD) and PowerPoint formats. If you aren't a registered OpsDog user yet, create a free account! New users get $20 off of their first purchase.


Questions?Call: 844-650-2888Email: info@opsdog.com
  • Workflow Template

    $15

    Medical Claims Processing

    - Instantly download files
    - Includes PDF, VSD, PPT file formats
    - Customize PowerPoint, Visio versions
    - Workflows mapped in BPMN 2.0

    Questions?

    Call: 844-650-2888

    Email: info@opsdog.com

Related Products

Looking for a custom solution?

OpsDog’s remote analytical team can provide custom, high quality data, reports and analysis for your organization with low cost and risk. Custom solutions include:

Questions?Call: 844-650-2888Email: info@opsdog.com

Let's find a solution that works for you. Fill out the form below and an OpsDog team member will contact you shortly to learn more about your needs...

Need help?
Call: 844-650-2888
Email: info@opsdog.com
TOTAL:
Tax will be calculated in the purchase step.
Continue to Payment
Please login to continue your purchase
Need help?
Call: 844-650-2888
Email: info@opsdog.com
Need help?
Call: 844-650-2888
Email: info@opsdog.com
Back to Top