Medical Claims Processing

Workflow Template

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.

Related KPIs : Claims First Pass Resolution Rate, Medical Loss Ratio, Percentage of Claims Paid In-Network

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.

Download a Sample Medical Claims Processing

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