Claims processing involves the verification of medical necessity for the reported procedures; this task is performed by:
A) medical office specialists.
B) medical directors.
C) medical review examiners.
D) automated claims processors.

Question

Quizplus · Accepted Answer

Medical review examiners are responsible for verifying medical necessity for reported procedures during the claims processing process. Medical office specialists may assist with the claims processing process, but they do not have the authority to make medical necessity determinations. Medical directors may provide guidance on medical policy and procedures but may not be directly involved in the claims processing process. Automated claims processors may assist with administrative tasks, but medical review examiners are required to make medical necessity determinations.

Claims Processing Involves the Verification of Medical Necessity for the Reported