Medical Claim Coding and Verification Process Template

Streamline your medical billing process by automating the extraction, verification, and coding of medical claims. This template ensures accuracy and compliance by systematically reviewing patient details, referrals, and procedure codes.

Note: This is a sample template. Contact us to customize it for your specific workflow or use case.

How this template works

1. An Operations Agent extracts key patient and procedure details, including names, service dates/locations, diagnoses, procedures, and provider information.
2. An Operations Agent verifies the referral document for readability, valid date (within one year and prior to claim date), and signature.
3. An Operations Agent confirms that the referring provider matches the provider listed on the patient charts.
4. An Operations Agent extracts relevant medical codes (ICD-10-CM, CPT/HCPCS), time units, charges, and modifiers from the documentation.

Why you should use a Medical Claim Coding and Verification Process template

Using this template helps reduce manual errors in claim processing, ensures compliance with referral requirements, speeds up the billing cycle, and improves the accuracy of medical coding, leading to fewer claim denials and faster reimbursements.

Who should use a Medical Claim Coding and Verification Process template

This template is ideal for medical billing specialists, healthcare administrators, coding professionals, and operations teams within healthcare organizations who are responsible for processing patient claims accurately and efficiently.