PHARMACY CLAIMS PROCESSING
What Is a Claim?
A medical claim is an invoice a doctor, or medical facility, sends to a health insurance company after a patient receives care. It provides details on the services the patient has received and the associated charges set by the doctor, or facility.
What Is Claims Processing?
Claims processing is an intricate workflow involving checkpoints that every claim must go through before it’s approved. If a claim makes it through all these checkpoints without issues, the insurance company approves it and processes any insurance payments. If it doesn’t, it gets denied, or sent back for more information.