Question

13.1

Explain the claim adjudication process.

13.2

Describe the procedures for following up on claims after they are sent to payers.

13.3

What is the definition of remittance advice (RA) and its use?

13.4

Identify at least three points that are reviewed on an RA.

Answer 1

13.1

Explain the claim adjudication process.

Claim adjustment process is a procedure to determine the legal liability , the coverage and then settling a claim.This process fulfill the promises of the insurer to its policy holders .It directly impact the reputation of the insurer in the settling claims and the retention of the policy holder .

13.2

Describe the procedures for following up on claims after they are sent to payers.

Answer

• When the insurance is lost , then the policy maker should send the notice to the insurer first
• Then the need to give a proof of the policy to exist by the insrer
• Reading the policy carefully
• mmeting the involved parties
• visiting the scene
• contacting the required authorities
• writing the captioned reports and supplementing the reports .

13.3

What is the definition of remittance advice (RA) and its use?

Answer It is basically a document which is sent by the consumer or the customer to the seller and informing that the invoice is paid by them .It is not mandatory .

13.4

Identify at least three points that are reviewed on an RA.

Answer

It is not mandatory

Mostl frequent in industries

Less common in general

Due to online payment system . reduced RA popularity and need

HAVE A GOOD DAY !