Credentialing

With all other process being automated this is one process where it requires manual feeding of data as 90% of the offices are still running paper forms for demographics.

Those days the insurance used to look up patients by last name and DOB or the social if the id number entered is incorrect resulting in the claim getting processed. But now the automated systems that validated the claim, rejects your claim even if one of these does not match.

Above all to meet the 5010 standards, the zip code has to be 9 digits, the race and the ethnicity of each patient has to be documented.

What can happen worst with incorrect data entered is that a claim that you assume that you have submitted to the payer would have been rejected by his EDI system due to incorrect information and you never know that the claim has never reached the payer. If you let this hang in there the filing limit would be lost.

It is very necessary that the beginning of each claim is right and this is the beginning.