How to Pay Insurance Claims

Insurance is a protection purchased by individuals, businesses and governments to protect an item, person or place from unforeseen damage or loss. When damage or a loss occurs, a claim is submitted to the insurance company to receive payment for the item or treatment of an injury. Paying an insurance claim involves reviewing the documents submitted by an individual, physician or business. The documents must include prices, proper coding if required and a description of the service or item. The item or service is paid at a value determined by the insurance company minus any copays, deductibles or schedules that limit payment.

Instructions

• 1

  Verify the policy holder and individual submitting the claim are correct. The information found on the policy should match the information submitted with the claim.

• 2

  Confirm the policy is active or was active the day of the loss. The loss date should be within the policy period. Claims are not paid if the policy was not active during the time of loss or injury.

• 3

  Determine the type of the loss. The type of loss could be health, auto, life or other insurable item. Policies require different information about the item, person or place that has experienced a loss.

• 4

  Review the extent of damage or treatment and circumstances of the loss. This will determine if the loss or injury is related to this claim for damages or previous loss/injury/conditions. The circumstances should appear comparable with the extent of the damage.

• 5

  Confirm the claim is written on the appropriate form with the correct pricing and coding if applicable. Medical claims must contain codes that explain treatment and diagnosis, while claims for items must have codes denoting the item being requested for payment.

• 6

  Calculate the claim payment amount after reductions applied by any copayments, deductibles or schedules that limit payment amounts.

• 7

  Distribute claim payments to providers, the insured or other third parties.