A claim that is removed from a payer's automated processing system for additional review is subject to:
A) preauthorization.
B) manual review.
C) medical-necessity examination.
D) claims edit.

Question

Quizplus · Accepted Answer

If a claim is removed from automated processing, it must be reviewed manually. This may involve verifying information, determining medical necessity, or resolving any coding discrepancies. Preauthorization and medical-necessity examination refer to specific types of review that may be required before services are provided or claims are submitted. Claims edit is a general term for automated checks that are performed during processing.

A Claim That Is Removed from a Payer's Automated Processing