Claim Resolution/Payment Verification Policy

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Screenshot of the first page of Claim Resolution/Payment Verification Policy

This policy outlines a set of procedures for ensuring all claims for a company are accurately estimated based on Medicare rates and/or managed care payer contracts, and resolved with the third party (i.e., primary or secondary payer) in a complete, accurate, and timely manner.

This policy applies to claims submitted by the company to third parties (e.g., Medicare, managed care payers, etc.) for services administered. Under this policy, managed care contract rates and Medicare rates should follow an established procedure for accurate, complete, and timely entry into tools used to re-price claims, according to established contract rates and estimated actual claim reimbursement.

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