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Insurance Type:

Medical Insurance: Electronic Claims

The provider's billing office enters information into their computer. Their program should already be compatible with the insurance administrator's program. This allows the claim information to be sent electronically. The insurance administrator's program accepts the transmission, then goes through steps to evaluate the information. These steps are:

Can the patient be identified?

Eligibility files are preloaded into the program, the program will attempt to match your name, date of birth, sex, and other identifying information with the preloaded information.

Can the provider be identified?

Networks will send electronic files to the insurance administrator with doctor's information, their degree, their specialty, their tax identification number, the address of their practice. The program will attempt to match this information with what is on the claim.

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