What does an insurance carrier typically do upon receiving a claim?

When an insurance carrier receives a claim, the typical procedure is to process the claim by verifying the information submitted and determining the eligibility for coverage. This involves checking the details against the policy provisions, ensuring that the claim is valid and that the services provided fall under the patient’s coverage. The processing phase ensures that every aspect of the claim is legitimate, which helps in preventing fraud and ensuring that only eligible claims receive payment.

This thorough verification process guards against incorrect or fraudulent claims and allows the insurance carrier to maintain financial responsibility. Claims must adhere to specific guidelines and criteria set by the insurer, and this step is critical in ensuring compliance with those regulations.

The other options provided do not accurately reflect the standard practices of insurance carriers. For example, issuing payment immediately without review would compromise the quality assurance needed to manage risk effectively. Rejecting all claims over a certain amount is also not typical, as claims are evaluated on their merits rather than their monetary value. Similarly, the requirement for electronic submission is not a universal standard across all insurance carriers, as many still accept paper claims under certain conditions.