After reading Chapter, Receiving Payments and Insurance Problem Solving, you will complete an outline of the outcomes. Your outline should be organized and concise.

Chapter Outlines:

1. Identify and discuss the claim adjudication, determination, and appeal processes. 2. Assess reimbursement payment time frames for all submitted claims. 3. Identify the components of an explanation of benefits document and interpret and post an explanation of benefits document to a patients account. 4. Discuss secondary insurance and guidelines to billing secondary insurance. 5. List and describe three health insurance claim management techniques. 6. Explain reasons for claim inquiries and identify strategies to discover why payments are delayed. 7. Define terminology pertinent to problem claims and discuss types of problems as well as find solutions. 8. Identify specific reasons for rebilling a claim. 9. Describe situations for filing appeals and discuss the review and appeals process. 10. Review Medicares five levels in the redetermination (appeal) process and determine which forms to use for each level. 11. Review and discuss the TRICARE review and appeal process, including expedited and non-expedited appeals, as well as reconsideration. 12. List four objectives of state insurance commissioners. 13. Mention seven problems to submit to insurance commissioners. 14. Discuss the type of information necessary to include in an insurance commission request. 15. Explain the importance of claim denial management.