The process of insurance claims involves the following steps:

• The patient visits his/her doctor and a diagnosis is made.
• The diagnosis is entered in the patient’s medical records.
• The records are sent for medical coding and billing.
• The procedure and diagnostic codes are identified and an industry-recognized code is assigned and transmitted to the insurance company.
• Based on the codes, the insurance company then decides on the adequacy of the coverage and the medical necessity of the services.

Medical coding jobs involve administrative tasks that demand a keen eye for detail, especially because it is a coder’s primary job to assign accurate codes for each claim. When the claim involves amounts over a certain limit, the insurance company has its medical staff review the claim and validate the payment based on various factors such as eligibility, medical necessity, etc. If validated, the claims are reimbursed to the patient. On the other hand, if a claim is rejected or denied for some reason, it is usually returned to the provider with an explanation. Thus, an insurance claim begins with a patient visiting a healthcare provider and ends with him/her receiving a payment from the patient’s insurance carrier.