Chapter 4, Problem 3R

Which of the following tasks should be completed prior to claim submission?   Coding the visit    Using the UB-20 form   Provider signing the claim   Manually sending the claim

To process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial. Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim. Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim. From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing? Please be sure to validate your opinions and ideas with citations and references in APA format.

Why do insurance companies practice things like restricting provider choice, gatekeeping, and pre-authorization?