What typically follows the submission of a healthcare claim?

Following the submission of a healthcare claim, the typical next step is claim processing by the insurance carrier. This process involves the insurer reviewing the claim to verify that the services provided were covered under the patient's plan and that the claim was filed correctly. During this phase, the insurance company assesses the documentation, checks for any necessary codes, and determines the amount to be paid to the healthcare provider based on the terms of the patient's insurance policy.

The processing phase is crucial because it ensures that the healthcare provider will receive compensation for their services in accordance with the coverage details. Issues such as missing information, discrepancies in coding, or non-covered services can arise during processing, which may lead to delays or denials in payment. Therefore, the focus during this stage is on the evaluation and adjudication of the claim by the insurance carrier to facilitate prompt and accurate payment.