Claims Review

Claims review is the process healthcare providers or insurance companies use to verify and evaluate medical claims submitted for payment. It ensures that the services listed are accurate, medically necessary, and properly documented according to policy guidelines. This review helps prevent errors, fraudulent claims, and overcharges, ensuring that payers are billed correctly and patients receive appropriate coverage. Essentially, it’s a quality check to confirm that the billed treatments match the provided care and comply with coverage policies before the claim is approved and payment is made.