If a third-party administrator receives an electronic healthcare claim, the
clearing house was most likely responsible for that claim's creation.
Explanation:
- When a clearing house creates an electronic healthcare insurance claim, it goes through a review process of adjudication.
- Several steps are followed during evaluation of the insurance claim.
- The claim charges are matched properly between the healthcare provider and the insurance company.
- In case of discrepancies, an appeal can be filed and the rules and regulations are followed to settle the disputes regarding the insurance.
- Maximum reimbursement is provided as per the agreed terms and conditions.
