Maricopa Community Colleges  HIT181   20032-20055 
Official Course Description: MCCCD Approval: 06/25/02
HIT181 20032-20055 L+L 3 Credit(s) 5 Period(s)
Medical Claims Processing
Application of third-party payer billing information to claims processing in the non-hospital setting. Use of the computer for claims submission. Management of claims to ensure confidentiality, data retention, and successful payment for services. Prerequisites or Corequisites: HIT185 and HIT212, or permission of instructor.
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MCCCD Official Course Competencies:
 
HIT181   20032-20055 Medical Claims Processing
1. Define selected terms related to computerized billing. (I)
2. Describe prevention measures to ensure computer confidentiality. (I)
3. Follow office procedures for manual and electronic claims processing. (II, III)
4. Explain the requirements for data retention and storage in relation to claims processing. (II, III)
5. Design, modify, and/or update superbills to reflect health care services. (III)
6. Explain the claims procedures for the major third-party payers. (III)
7. Prepare claims for submission to major third-party payers. (II-IV)
8. Develop policies and procedures for managing insurance claims. (IV)
9. Prepare supporting documentation as needed for proper claims processing. (IV)
10. Verify benefits with third-party payers. (IV)
11. Describe steps taken to resolve delinquent and/or denied claims. (IV)
12. Prepare claims for rebilling. (IV)
13. Respond to requests for claims review and appeal. (IV)
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MCCCD Official Course Outline:
 
HIT181   20032-20055 Medical Claims Processing
    I. Computer Basics A. Computer terminology B. Confidentiality
      II. Electronic Data Interchange
          A. Computer claims systems
          B. Data interchange
          C. Data storage
        III. Claims Management
            A. Superbill/source documents
            B. Claims processing and payment methodologies
              1. Managed care systems
              2. Commercial insurance carriers
              3. Medicaid and state programs
              4. Medicare
              5. CHAMPUS, CHAMPVA, and TRICARE
              6. Worker's compensation
              7. Disability income and benefit programs
            C. Alternative care providers
          IV. Reimbursement Management
              A. Policies and procedures
              B. Documentation
              C. Explanation of benefits
              D. Problem claims
              E. Rebilling
              F. Review and appeal process
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