Claim Resolution/Payment Verification Policy

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Screenshot of the first page of Claim Resolution Payment Verification Policy

Organizations can use this policy to ensure that claims submitted to third parties for services administered are estimated accurately and resolved in a timely manner.

In this sample, all managed care contract rates and Medicare rates should follow an established procedure for accurate, complete and timely entry into tools used to re-price claims, according to established contract rates and estimated actual claim reimbursement. Denials, appeals, write-offs, underpayments, refunds, etc. should be appropriately handled in a complete, accurate and timely manner. Individuals responsible for resolving the company’s claims should follow an established and standardized procedure outlining follow-up activities related to claim resolution

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