Healthcare payers base their decision to pay or deny claims on the:
A) diagnosis codes only.
B) procedure codes only.
C) diagnosis and procedure codes.
D) neatness of the claim.

Question

Quizplus · Accepted Answer

Healthcare payers base their decision to pay or deny claims on both diagnosis and procedure codes. These codes give a detailed description of the medical services provided, which helps payers determine if they are medically necessary and covered under the patient's insurance plan. The neatness of the claim may affect the time it takes for it to be processed, but it is not a determining factor in whether the claim is paid or denied.

Healthcare Payers Base Their Decision to Pay or Deny Claims