What is Medical Claims Processing and Billing
                     What is 
Medical Claims 
Processing and 
Billing?
www.mgsionline.com
 Whether you are a new Provider or an established healthcare practice, providing 
extra care to the medical claim processing sector is the only way to improve 
cash flow. 
 Although patient care is the key focus of Physicians, many are new to the 
industry and lack the experience to handle medical billing. 
 Well, it doesn’t mean that experienced Providers are well-versed in claims 
processing, as some of them lack the latest technology & software or 
professionals skilled in the new healthcare reforms. 
 In either case, outsourcing medical claims & billing is the best option! In 
order to learn why it is the right solution, Providers should understand how 
complex is the medical claims processing and billing. This article 
emphasizes just that:
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What is Medical Claim Processing? 
 Then Providers render medical treatment 
to patients, they get paid by sending out 
bills to Insurance companies covering the 
medical services. 
 It involves a lot of steps. Firstly, claims 
are prepared by assigning specific ICD 
(used for diagnoses) and CPT (used for 
treatment) codes to the medical services 
provided. 
 These claims contain important 
information like patient demographics 
and plan coverage details. 
 Then, the claims are submitted to the 
Payors. 
 The insurance companies evaluate each 
claim and reimburse it accordingly. www.mgsionline.com
Medical Claim Billing in Depth:
 Medical claim processing is not as 
simple as a walk in the park. 
 It is a complex task that can be carried 
out only by skilled professionals who 
have great attention to detail, immense 
training in the new coding techniques, 
good communication skills, and 
knowledge on current healthcare trends. 
 To be qualified by the Payors, claims 
have to go through many technical 
protocols and pass industry standards. 
 HIPAA is one such standard that ensures 
high-level security during patient data 
transmission. 
 Processed claims are filed electronically 
to expedite the process and improve 
www.mgsionline.com efficiency.
Clearinghouses
 The next step in medical claim 
billing is clearinghouses to which 
processed claims are sent to. 
 It is a third-party hub that operates 
between the Provider and the 
Payor. 
 Clearinghouses sort out all claims, 
scrub them for errors, format as per 
industry standards, and send to 
various insurance carriers.
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Explanation of Benefits:
 After evaluating the claims, the insurance 
companies reimburse the Providers or 
reject erroneous claims if any. 
 They should also provide EOB 
(Explanation of Benefits) to patients as 
well as Providers. 
 EOB is a statement that shows several 
details like dates of treatment, diagnoses, 
charges, Providers’ reimbursed amount, 
and patients’ financial responsibility.
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Why Outsource?
 Anything can go wrong in this huge, complex 
process. 
 Therefore, the in-house billing team should 
perform medical claim processing exceptionally 
well and conduct multiple audits before filing 
claims. 
 If the team is not competitive enough to handle, 
then Providers can opt for outsourcing medical 
claim billing.
www.mgsionline.com
www.mgsionline.com
About Us
 If you are on the lookout for an experienced 
medical billing company, then consider MGSI, 
which has more than 20 years of experience in the 
healthcare domain. 
 Based in Florida, this company possesses the latest 
technologies and software solutions to process claims 
without errors. 
 MGSI is A+ rated company with Better 
Business Bureau. 
 To learn more details, log on to www.mgsionline.com.
THANKS
Do you have any 
questions?
Mail Us: 
[email protected]
Call Us: +1 877-896-6474
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