Instructions

The insurance payment process in managed care has several steps. In this assessment, create a timeline of the steps involved in the claim process from the patient encounter through the payment.

Evaluation Title: Patient Claim Process

Assume the role of a claims process manager in a primary care medical office. An existing patient comes in to be seen for a knee injury sustained over the weekend playing football with children. A full physical exam is done, and three x-rays are taken. The patient is provided with a referral to orthopedics, as well as two prescriptions for an anti-inflammatory and a pain medication. The patient is also provided an ACE elastic wrap in the office and shown how to properly use compression wrap on the injured area.

Instructions:

  • List the steps of the patient claim process from the conclusion of the appointment through the MCO payment.
  • For each step, provide the following:
    • A brief description of what is happening in each step of the process.
    • Estimated time for completion of each step.
    • Responsible parties and others involved in each step.

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