The life cycle of an insurance claim is the process of an health insurance claim. It goes from the time the claim is submitted by the provider to the time it is paid by the insurance carrier. There are four basic steps to the life cycle of an insurance claim. Those four steps are submission, processing, adjudication, and payment or denial. It all begins with the patient initial phone call setting up an appointment. Even if the patients is new or past or is calling because of an referral, the phone call is critical. You must ask the patient questions to get more information regarding the reason to the appointment. For example, did they confirm the date of birth, or verify the necessary insurance information regarding eligibility and benefits.
RBC first established its insurance platform in the early 1980s where it promoted creditor and basic travel insurance, as those were the few products that can be promoted by bank employees under Canada’s Bank Act. Through the acquisitions of various insurance companies, they eventually entered the life, health, property and casualty insurance markets; demonstrating significant growth in the industry and eventually being level in the playing field among other large insurance competitors (McLaren, Babin, & Schuster).
-A monthly claim report lists all claims the insurance carrier has denied or not paid by the required time limits set by the state. It also has a listing of detailed information about the claim itself to better identify the exact claim listed. The monthly claim report is necessary for reimbursement because they must be sent to an auditing team to make sure the correct attention to the overdue claims so that they are paid and if not paid the provider should be send a notice on why the claim is not being paid or why the provider is going to be receiving a partial payment. This is called a remittance advice sent to the providers office so that they claim may be edited and resubmitted.
20th Century Insurance was established in 1958 and was the first company of its kind to sell automobile insurance without a middleman, known in the industry as a broker or agent. This direct sales approach allowed 20th to offer insurance at a much lower premium than its competitors. To date, 20th Century Insurance is still recognized as one of the most economical full service automobile insurers in the California market.
Allstate insurance is the second largest property and casualty insurance company by premiums in the United States. Allstate insurance handles about 12% of the U.S home and auto insurance market. (Allstate, 2014). Many of Allstate’s customers fall under what one could refer to as a traditional selection of insurance for automobiles. Recently, Allstate has noticed a major shortcoming in lifestyle insurance, which includes coverage for motorcycles, boats, and other recreational vehicles, in comparison to its competitors. The motorcycle insurance sector is a 10.4 billion dollar industry and growing (PRWEB, 2012). The U.S. Department of Transportation website reports some astounding figures, including that 5,370,035 motorcycles were registered three years before the article, 7,138,476 motorcycles registered at the time of the article, and grew to 9,477,243 registered motorcycles at the end of 2012 (NHTSA, 2013). It is obvious as to why Allstate would identify motorcycle insurance as a worthy lifestyle product to devote marketing research dollars into in order to develop new strategies for cornering a share of the market.
The first step is to pre-register the patient's insurance information into the computer system and making a copy of their insurance cards. The patient's insurance information would then be verified. The patient would then be seen by a medical professional to examine the patient, discuss any test results or provide a diagnosis. Once the patient is ready to check out any payment due would be collected. The medical coder would then go over the patients' medical record and assign any diagnosis codes or procedural codes and then a claim form (CMS 1500) would be completed and submitted. The payment would also receive and posted at this time and document in the patient's record. The CMS 1500 will information from the patient, including the type of
The types of primary payers can also be considered as secondary payers. The possible errors that can occur on claims as a primary and secondary payers are consisted
There are three types of life insurance that most insurance companies offer, which are, universal, whole, and term. Universal life insurance is a permanent policy consisting of two parts, which are term insurance and an investment/cash value feature-which is interest bearing. The premiums for the plan allow the policyholder to pay a minimum rate when necessary or to pay the maximum and provide funds to the cash value of the policy. The more that’s paid into it, the bigger the investment/return. With the cash value of the plan, fees are deducted for the costs of the plan and the policyholder receives payment from the interest of the remaining balance. Universal offers clients a definite minimum interest rate on the cash value. Some insurance companies offer a tiered interest rate that pays policyholders a fixed percentage up to a certain amount, then a higher interest rate on balances above that threshold.
As of October 17, 19996, Mr. Bruce Goldberger has been a Client with VALIC (Variable Annuity Life Insurance Company) under his Employer (University of Florida) sponsored group plan. Mr. Goldberger currently has 8 active contracts with a combined total of $632,571.25. Mr. Donald Hartman has been Mr. Goldberger’s appointed agent as of 2015.
Insurance companies exist to make money. They are not concerned with your needs which include great coverage at an affordable price. Their agenda consists of offering superfluous offers, causing you as a customer to lose money on frivolous items that won’t ever benefit you.
Patel, Kavita. “Helping Consumers Understand and Use Health Insurance in 2014” Institute of Medicine. Institute of Medicine. 29 May. 2013. Web. 31 Jan. 2014. .
History of Case Management The concept of case management was first introduced in the 1970’s by insurance companies as a way to monitor and control costly health insurance claims, commonly created by a catastrophic accident or illness (Jacob & Cherry, 2007). Today, almost every major health care organization has a case management program managing and directing the use of health care services for their clients. Also, case management by payer organizations is recognized as external case management. Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007).
This concept was a hard one to grasp. For my interview summary papers, I decided to interview my preceptor over the health care and different insurance policies. One thing that was brought up was the requirements on the insurance policies constantly changing. It could be one way the first day but then they add more information that will eliminate several people from getting that insurance. There are medical insurance companies that provide help for people who are do not make enough money but they often will deny people service due to making too much money.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
“Part super-hero. Part fortune-teller. Part trusted advisor (“Be an Actuary.”).” An actuary is all this, they are crucial apart of the world of business. Actuaries work in both the public and private sectors of business. They are manly in the administrative part of the work place. They are in every large corporation and in even some of the smaller companies. Actuaries are most often in insurance companies and large corporations; though they are even in so financial planning businesses (“Be an Actuary.”). They are also the people that run financial calculations for both individuals and businesses (Hezzelwood). With being such an important part of business actuarial science is a very good field to go into. Forbes has ranked actuarial science as the best job in 2013 (Smith). Actuarial science is constantly ranked one of the top jobs to have in America (“Be an Actuary.”). There are many things that factor into making actuarial science the best job in America.
As I started my Health Insurance class my belief was that this class will be pretty easy as I am familiar with much of the medical field. Personally having multiple illness’s and having three special needs children, personally I have learned so much within the medical field. However, as I began reading Chapters 1-3 in my Understanding Health Insurance book, the realization hit that I was not as knowledgeable as I thought I was. Therefore, I am eager and excited to learn new things in the medical field.