Best Practices in Processing Health Insurance Claims

Rely on the Practical Guidance Healthcare practice area for a comprehensive checklist addressing claims processing issues. Educate yourself on the relevant laws, regulations, and administrative rules governing the process; discover relevant claims processing timelines and claim forms; and equip yourself with the necessary questions to understand your clients’ particular obligations.

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Related Content

• Balance Billing and Other No Surprises Act Rules
  Get up to speed on the principal provisions of the No Surprises Act. Ensure your clients stay compliant with federal law prohibiting surprise billing of participants, constraining participant cost-sharing obligations, and establishing a mandatory negotiation and arbitration process to resolve reimbursement rate disputes.
• Federal Healthcare Program Exclusions Prevention Checklist
  Ensure your clients—including health systems, hospitals, physician groups, and individual practitioners—are not excluded from participation in Medicare, Medicaid, and other government-funded healthcare reimbursement programs.
• Health Insurance Payment Systems State Law Survey
  Don’t run afoul of state law requirements addressing required coverages in healthcare insurance policies. Review this 50-state survey for more information on mandated benefits reviews, reviews of coverage denials and claims, and requirements on physician financial incentives and premium rating types.
• Drug Reporting Rules Present Challenges for Many
  Download the Mercer Law and Policy Group’s 20-page article summarizing prescription drug reporting rules and learn how the 2021 Consolidated Appropriations Act requires group health plans and health insurers to report prescription drug pricing and healthcare spending.

Practical Guidance Updates
Featuring the latest updates from your Practical Guidance account.   

• Learn about the Medicare process, including how payments are made and how to appeal denials, via practice notes on Medicare Reimbursement and Medicare Reimbursement Appeals.
• Commercial insurers, and the attorneys who represent them, should use the Complaint and Grievance Procedures in Health Insurance Checklist to review the structure of the complaint and grievance review process and see how to conduct legal research on the topic.
• Law students and new attorneys, find the information you need—practice notes, templates, and checklists—to understand, address, and complete common healthcare-related tasks in Practical Guidance’s Summer Associate Resource Kit: Healthcare and First Year Associate Resource Kit: Healthcare.
• Listen Up! The Practical Guidance Podcast features interviews with industry-leading attorneys on cutting edge issues in the law: NFTs, Cannabis, COVID-19, and more. Catch the most recent episode on the podcast platform of your choice.
• The Practical Guidance Journal Summer 2022 Edition leads with an article on ransomware issues in the healthcare industry and includes LexisNexis Legal & Professional resources to support the people of Ukraine.
• Check out the new Practical Guidance Author Center! Learn about the 1500+ leading attorney authors contributing to our 21 practice areas, and find out how you can Become a Practical Guidance Author.​​​​​​
• Document alerts allow you to stay current on legal developments that affect your practice. Find out how to set up your document alerts.

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