Example Of Research Paper On Difference Between Explanation Of Benefits And Remittance Advice

Health insurance benefits tend to subject their users to instances of confusion; the confusion emerges from the health statements issued to patients indicating various benefits (Jung, 2012). The major two types of health statements used that have subjected their users to situations of confusion are remittance of advice and explanation of benefits (Jung, 2012). However, these statements have certain differences that can be used to avoid associated confusion. To begin with, both remittance of advice and explanation of benefits assist their users with data regarding health benefits, however, remittance of advice is usually directed to the medical service providers while the explanation of benefits is directed to a patient insured (Jung, 2012). The other difference emerge on their content, the explanation of benefits describe to the patient information regarding the benefits of a health service insurance, while the remittance of advice may indicate information ascribed to deductibles.

Clean, Dirty and Incomplete Claim Form

In the perspective of health statements, clean claim forms usually indicate all necessary data for purposes of processing. They are usually submitted and processed in a timely and appropriate dimension (www.mattsinsurance4ca.com). On the other hand, dirty claims are described as characterized by existence of errors, thus may be subjected to manual processing, an instance associated with delayed payments (www.mattsinsurance4ca.com). In relation to incomplete claims, they basically lack pertinent information; this means that they may be subjected to correction or in some cases; providers may be compelled to re-submit them (www.mattsinsurance4ca.com).

References

How Health Insurance Claims Processing Works. (n.d.). Retrieved March 11, 2015, from http://www.mattsinsurance4ca.com/Insurance-Claims-Processing.html
Jung, M. (2012). Explanation of Benefits and Remittance of Advice Forms. New York, NY: American National Standards Institute.