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Module 6: Claim Submission
Build a clean claim, understand the fields that cause rejections, and follow it through adjudication to a correctly posted payment.
2
Lessons
46
Minutes
Practice
Files Included
Intermediate
Level
What You'll Learn
- The CMS-1500, the 837P transaction, and the fields that most often reject
- The difference between a rejection and a denial, and why it changes what you do
- What claim scrubbing catches and why it pays for itself
- Reading a remittance and posting payment, adjustment, and patient responsibility
Real-World Scenario
Twelve claims come back the same afternoon, before any payer looked at them clinically — invalid subscriber ID, missing NPI, a diagnosis pointer referencing a diagnosis not on the claim. None are coding problems. All twelve were preventable.
Lessons
Complete each lesson in order. Watch the video, review the notes, and finish the challenge.
Lesson 1⏱ 24 min
📤The CMS-1500 and What Each Field Carries
Understand the professional claim form, the electronic transaction behind it, and the fields that most often cause rejections.
Lesson 2⏱ 22 min
📤Claim Scrubbing and Submission
Catch errors before a claim leaves the practice, and understand the path a claim takes from submission to payment.