 Being the new reimbursement manager, I hope to work with you all for the benefit of this entity.  I manage reimbursement transactions, as well as facilitating training to executive staff on new policies.  I take part in the preparation of departmental budget.  I also negotiate for contracts with outside vendors.  Generally, I am responsible for keeping track of all files, in this case reimbursement files in relation to insurance.

 Developing strategies to facilitate consumer support in relation to issues of reimbursement.  Management of transactions.  Training and coaching executive staff on new policies (Marylyn, 2007).  Analyzing and interpreting financial data, as well as cost reports.  Building relationships with staff and insurance providers.  Use software programs to keep track of data records.  Medical coding.  Get payments made on overdue accounts.  Establish connections with the insurance companies and the representatives.

 PAPER CLAIM  Submitted manually and delivered to insurance companies.  Take around 60 to 90 days for processing.  More expensive considering the time and processes required.  High chances of inaccuracies.  ELECTRONIC CLAIM  Billing claims for services are done through electronic means.  Care provider uses a software to ascertain the eligibility of the patient for the needed services.  Uses the same technological standards as the electronic claims transmission.  The response if received by the payer t through a direct electronic connection.  This is referred to as the health care eligibility and benefit response.

 Turn over time is 40/60/  Rejections are valued at 35% depending on clerical errors.  Cost of paper claim us $7.  The time on each claim is approximately 10 minutes.  The average rejection rate due to electronic errors is 2%  They are prioritized over paper claims.  Paid between seem to twenty one days.  Follow up procedures are drastically reduced.  Reduced cases of adjudication errors.

 Assignment. The auto claim is assigned to professional, endowed with the responsibility of guiding you through the entire process with the help of a team of claim specialists,  Initial contact. Claims professional communicated with you concerning the auto claim. This enables him to:  Obtain initial information about the loss.  Explain how the claim will be managed.  Suggest ways to prevent damage in future.  Schedule an in person appointment.  Evaluation. Claims professional conducts inspections to determine presence and extent of loss. Facts are gathered. Documentation is made. Witness is interviewed. Photos are taken. Formal evaluation of claims are made.  Resolution. Claims professional issues payment based on estimates. Claim closure. This is done in accordance with the terms of policy.

 Electronic data interchange is the technological process of moving data within organizations in structures formats.  This technicality allows transfer of information from one location to another.  It is important since it facilitates the change of information between various parties in a business transaction (FOURDNEY, 2013).  Allows paperless transfers of unimportant data.  Enables electronic commerce.  Automates business processes.

 This is the process a health insurance claim goes through since its submission to its payment.  Submission. - Transmission of the claim to the insurance provider electronically in the case of our organization.  Processing. - The payer collects information about the patient, the medical service provider and concerning the services to be delivered.  Adjudication. -Editing of provided information is facilitated. -Verifications are made concerning health benefits and payer rules. - The services which have been billed are confirmed.  Payment/denial. -Claims can either be denied or accepted by the payer. -The payer may generate a remittance or explanation of provided benefits at this stage. -An explanation is given on how the claim was processed. -A cheque is mailed together with the specific explanations. -Payment is received by the medical service provider. -It is posted into the patient’s account. -Remaining balances are billed out to the patients.

 Took too long to file the claim. Beyond 60 to 90 days is a late presentation of claims and this my be a reason for their rejection.  Lack of proper codes.  The diagnostic codes and the procedure codes may be incomplete, invalid or missing.  Preauthorization or authorization.  Lack of preauthorization is a direct rejection of the claim.  Expiry of claim (Marc, 2002).  If the claim is not posted before the deadline, this is a late claim and may be rejected.  Lack of referral from a physician.  This in most cases leads to a delay.  Provision of more than required number of services in one day.

 Health insurance is important in various ways.  Preventive services can be accessed.  Financial distress is eliminated.  Soon treatment is obtained.  Insurance claims are helpful since compensations are a source of burden reduction to the individual.  The use of electronic claims should be encouraged.  This is because of accuracy and efficiency as compared to paper claims.  Insurance providers should not be discriminative in the case of service delivery.

Marylyn, F. (2007). Administrative Medical Assisting. London: Cengage learning Fourdney, M. (2013). Insurance Handbook for the Medical Office. London: Routledge publishers Marc, S. (2002). Manual Reimbursement for Meical Genetic Services. New York: John Wiley and sons