What happens after a claim is approved for payment?

When a claim is approved for payment, a remittance advice is sent to the provider. This document serves several important purposes. It provides the provider with a detailed statement about the claim's processing outcome, including the amount that has been paid, any adjustments made, and information on the coverage of the services rendered. The remittance advice is crucial for providers to manage their billing practices and ensure they are compensated accurately for services provided.

In the context of processing claims, while patients may eventually receive a bill for their share of the costs, the immediate response to an approved claim is the communication with the provider. This ensures that the provider is kept informed of what is reimbursed and what outstanding balances may need to be addressed with the patient.