Medical billing Claim Types

Paper, Electronic, Clean, Dingy, Dirty, Rejected, Incomplete, Invalid, Participating Provider, Unprocessed and Dropped.

Tracer

            An enquiry made to Insurance Company to locate the status of an insurance claim as a follow up for data that is missing.

Tickler File

            It is used to remind patient of the upcoming or missed appointment as well as to track submitted, pending or resubmitted insurance claims. It is also called suspense or follow-up file.

Dropped Claims

            These are the claims rejected by the Clearinghouse due to wrong details or lack of information checked during the Preliminary Screening.

Unprocessed Claims

          These are claims that are rejected by the Insurance Company normally as a result of Prepayment edit/Pre-audit respectively.

Participating Provider Claim

            Claim sent on behalf of participating provider for reimbursement. These are processed within approximately 14 days of receipt. Non-participating provider claims are processed within approximately 27 days of receipt.

What is Invalid Claims

           It is any claim that contains complete, necessary information but is

Illogical or incorrect (e.g. listing incorrect Provider # for a Referring Physician).

These are to be resubmitted.