Discussion: MCO payment Discussion: MCO payment The insurance payment process in managed care has several steps. In this assessment, create a timeline of the st

Discussion: MCO payment

Discussion: MCO payment

The insurance payment process in managed care has several steps. In this assessment, create a timeline of the steps involved in the claim process from the patient encounter through the payment.

Evaluation Title: Patient Claim Process


Assume the role of a claims process manager in a primary care medical office. An existing patient comes in to be seen for a knee injury sustained over the weekend playing football with children. A full physical exam is done, and three x-rays are taken. The patient is provided with a referral to orthopedics, as well as two prescriptions for an anti-inflammatory and a pain medication. The patient is also provided an ACE elastic wrap in the office and shown how to properly use compression wrap on the injured area.



List the steps of the patient claim process from the conclusion of the appointment through the MCO payment.

For each step, provide the following:

A brief description of what is happening in each step of the process.

Estimated time for completion of each step.Responsible parties and others involved in each step

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