Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)

• Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.

• Supporting details/ justification available in EMR of all investigation done.

• Checking all CPT codes entered are correct based on CPT guidelines.

• Checking excluded ICD and CPT based on Coding guidelines.

• Approved services and rendered services are match.

• Ensuring all requested investigations are done and invoiced.

• Check the claim with correct Receiver and Payer name before finalizing the bill.

• Check the claim with correct Patient Copay application.

• Ensure all claims are submitted to insurance company.

• Check the payer’s name, rate plan and plan name selected properly.

Submission Supervisor Checklist & Responsibilities

• Maintain Production sheet

• Allocate production claims details to submission team based on the claims generated data.

• Every month create production xl and document each staff wise daily production count.

• Sharing of daily production details and claims status to Sir JP.

• Maintain monthly Claims status

• Downloading 16 facilities claims generated count and update in the claim’s status XL daily.

• Based on the data maintain finalized claims and pending claims details in the same xl.

• Maintain Correction claims details

• Monthly Create new folder in the sharing folder to maintain correction details for each centre wise.

• Share the correction details to respective clinic team.