Clinical
Claims Processing
Review and adjudication of submitted healthcare claims by a payer.
Definition
Claims Processing is the review and adjudication of submitted healthcare claims by a payer.
Why it matters
Understanding the claims process helps agencies identify why claims are paid, denied, or returned for additional information.
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What Should I Document? 100 OASIS Situations Home Health Nurses Face Every Day
100 real OASIS scenarios, worked end to end — clinical situation, common mistake, better approach, and key takeaway. Built around OASIS-E2 (effective April 1, 2026) to turn what you assess into accurate, defensible documentation.
Download Free eBook226 pages · 15 chapters · PDF
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Conversations on clinical
Episodes from Inside Home Health that put Claims Processing in operational context.
