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Claims Processing

Students will gain an understanding of the complete cycle of claims processing in this module. They will also learn how to recognize form locators and the sections they apply to on a CMS-1500 form as well as understand plan participation and payment methods. In addition students will learn how to differentiate between a rejected and denied claim form. Students will also learn anatomy and physiology of the cardiovascular, lymphatic, and immune systems. Pathophysiology and pharmacology related to these systems will also be discussed. Pathology and Laboratory services and procedure coding guidelines will be introduced. Students will learn the basic identification and method of code assignments, coding, and classification systems in order to assign valid diagnostic and or procedure codes using ICD-9, ICD-10, CPT, and HCPCS manuals. By the end of this module students should feel comfortable using coding manuals as well as logic based computerized coding software.


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