The document outlines the process for billing clinical services and submitting insurance claims at a healthcare organization. It describes preliminary checks to determine patient eligibility and collect required documents like insurance cards and physician approvals. These documents are then arranged by insurance company, a summary statement is generated, and the claims are dispatched to the companies by the 10th of each month. Tracking is kept to ensure the batches are received.

1. Checks & Controls
By: Abbas Ahmed
abbas.ahmed@shroukalhada.com
E-Claim
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2. Billing & Claim Submission
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OBJECTIVE
The core objective are to manage timely billing of clinical
services once records are provided by the Advac System, and
oversee the associated collection and reconciliation of those
accounts.
The process for completing these tasks takes significant
coordination from the front desk staff, to end users, billing office,
to performance accurate revenue reports as well as reconcile it
with the insurance companies
E-CLAIM / BILLING SECTION

3. System Preliminary Checks
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• If yes proceed for further action please
• If not, patient needs to pay cash
Patient Eligibility

4. System Preliminary Checks
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 UCAF along with Visit Invoice
automatically Printed from Software
Collect Patient ID Card/Insurance Card
(Copy)
Patient Signature on UCAF
Approval if required
Sign & Stamp by Treating Physician on UCAF
Referral documents if required
Diagnosis, Chief complaints must be readable on UCAF
UCAF Checks
Any Other New Requirements by Insurance Companies / CCHI

5. Patient Flow
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Supporting Documents & Flow
Insurance Card
Copy
Iqama Copy
Consultation
Invoice
*If exceed amount limits*If chronic /over a month medication*Dental/gyne/optics
UCAF
**Approval
Investigations
Results
Lab/X-ray
Order Sheet
Prescription
Pharmacy
Invoice
Invoice**Approval
**Approval

6. System Preliminary Checks
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Arranging Documents
•Printout All Invoices/Supporting Documents
•Arrange Company and Sub-Company Wise as required by
insurance company
•Final Summary Statement
•Sign by Authorized Manager
•Dispatch to Company through registered courier
•Keep Tracking either they received batch or not

7. System Preliminary Checks
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Claim Tracking
•Submit Summary to Accounts Department
•Enclosed courier copy/dispatch bill with monthly bills
E-CLAIM / BILLING SECTION

8. 10th of Every Month
Deadline
for
Claims
Submission
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Thank You