Assume the role of a claims process manager in a primary care medical office. An
ID: 137866 • Letter: A
Question
Assume the role of a claims process manager in a primary care medical office. An existing patient comes in to be seen for a knee injury sustained over the weekend playing football with children. A full physical exam is done, and three x-rays are taken. The patient is provided with a referral to orthopedics, as well as two prescriptions for an anti-inflammatory and a pain medication. The patient is also provided an ACE elastic wrap in the office and shown how to properly use compression wrap on the injured area.
Instructions:
List the steps of the patient claim process from the conclusion of the appointment through the MCO payment.
For each step, provide the following:
A brief description of what is happening in each step of the process.
Estimated time for completion of each step.
Responsible parties and others involved in each step.
Explanation / Answer
Patient claim process from MCO the conclusion of the appointment through the (Managed care organization) payment..includes the following steps:-
The Title X confidentiality regulations are among the strongest in current law.
Patient Records, Enrollment, and Decision-making
Paper Claims Submission
Claim Appeals
Medical Necessity Appeal