Understanding the Medical Billing Process: Step-by-Step

Electronic Data Interchange (EDI) transmission

Claim scrubbing to remove errors before submission

Billing platforms integrated by companies like DocVaz.com help prevent rejections by flagging issues early and ensuring clean claim submission.

Step 7: Claim Adjudication

Once the claim reaches the insurance company, it undergoes adjudication. This is when the payer reviews the claim and decides:

• How much to pay the provider

• What portion (if any) the patient owes

• Whether to deny the claim based on errors, eligibility, or policy limitations

Outcomes can include:

• Full approval and payment

• Partial payment with explanation

• Rejection with denial reason

Step 8: Patient Billing and Payment Collection