The Claim Lifecycle
Claims within Remits begin life when remittance advices are received, with denials creating cases to queue follow-up. Once follow-up is complete and denied claims are paid, cases are automatically closed and claims marked as "paid".
Remittance Advice Import
Healthcare claims submitted to insurance companies are paid or denied after adjudication. These payments and denials are returned on remittance advices, which is the claim's entry point into Remits. These remits are either manaully keyed, or automaticaly imported into Remits.
From the received payment data, Remits is able to reverse-engineer the original claims sent to insurance companies. These claims are then stored and used as a reference point for future transactions.
For any claim with non-contractual claim adjustments (denials), Remits will generate a case. Cases serve as a "ticket" of sorts where billers can record any and all activity related to the claim.
After denials are handled and corrected claims submitted, claim status is updated in Remits and the response form the insurer is waited on.
Once final payment is received and posted, cases for fully-paid claims are resolved and marked "paid".