In an ambulatory care setting, you should receive receipts from insurance companies that have paid for services for its subscribers. The receipts details what services and procedures were or were not paid for. You will need to read the receipt in its entirety. Depending on the type of insurance, the provider may have to take a loss or charge patients the remaining balance that the insurance company did not cover.
If you have not received any payment within 10 business days of submitting a claim, you need to call the insurance company and ask why the claim has not been paid. Most insurance companies will not pay on a claim if it is dirty or incomplete.
Use your textbook, the Internet, or other resources to complete this assignment. Write a one-page paper defining and explaining the difference between an “explanation of benefits” and a “remittance advice.” Then explain clean, dirty, and incomplete claim forms.
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