What is a medical claim? A medical claim is a bill for services provided by a health care provider, forwarded to an insurance company for payment. The claims made by a person or on his behalf by the hospital, will cover only those expenses that fall under the parameters of the policy chosen. So careful research must be done while choosing the policy.
There are different types of medical claim forms. Some of them require a direct interaction between you and the insurance agent, while others are routed directly through the hospital. For those forms, that require the claimant to fill out all the details in the medical claim form, there are certain aspects that need to be kept in mind. The medical claim forms require way many details and it is important that they are filled out with utmost attention. Wrong entry or a missing entry can cost the whole claim being denied.
Medical claim forms ask for details such as name, age, sex, bank account numbers, relationship status, place of work, the nature of illness, number of days applied for leave. Apart from these, the date of admission into the hospital and the date of discharge and the amount charged for the services are also asked.
There are different types of medical claim forms. Some of them are Balance Forward Bill, Form 1500, which is otherwise called HCFA and UB-04. Each has a different method of paying the provider for the services.
The Balance Forward Bill is a simple bill sent by the medical provider to the patient for the services provided. This does not include the necessary details that are required by the insurance agent. The most commonly used medical claim form is the Form 1500 or HCFA. This is of the standardized format. This is either forwarded to the insurance agency, if the medical service provided is contracted to the same. Otherwise, the patient gets to pay for the services initially and these medical claim forms can be sent to the insurance agent for reimbursement. The other type of medical claim form is the UB-04, which also works like the HCFA.
Most of the insurance claims require standardized medical claim forms. This is because the medical claims are processed using a unique code. Once a claim is submitted, the system scans the claim using the patient information and the unique code and processes the claim based on the plan chosen.