The following excerpt was originally posted on RevCycleIntelligence.com, on March 9th, 2015:
"Although reimbursement is a vital aspect within a claim’s life cycle, it is certainly not the only vital piece. It is important to recognize and distinguish each stage from the other within the total life cycle of a medical claim to decrease errors and cost.
A claim goes through a multi-fold process before it becomes eligible for payment. An ineligible claim will either be denied or be corrected so it can then become eligible.
In the initial entry phase, a claim begins in either paper form or electronic form via Electronic Data Intercharge or Web Portal. The Enterprise Database Management System scanned paper submissions for Medicaid Information Technology (MITS) availability, enters and verifies required data. Claims are classified as Encounter Claims or fee-for-service claims.
MITS performs validation using provider contracts, recipient benefit plans, and reference code set information. This is where the proper codes are recorded."