US Healthcare Claims Lifecycle Explained Simply | 837, 835, EOB & ERA | PM & BA Guide

Ever wondered what happens after a patient visits a doctor and the hospital submits a claim to the insurance company? In this video, we explain the complete US Healthcare Claims Lifecycle, from patient registration and medical coding to claim submission, adjudication, payment, and denial management. Using a simple $500 medical claim example, you'll understand how healthcare providers, clearinghouses, and insurance payers work together. Topics covered: What is a healthcare claim? Medical coding: ICD-10, CPT & HCPCS Claim creation and submission (837) Role of a clearinghouse Claim rejection vs denial Claim adjudication and payment calculation Electronic Remittance Advice (ERA/835) Explanation of Benefits (EOB) Claim denial management Complete end-to-end claims lifecycle Timestamps: 00:00 Intro 01:00 Claims lifecycle 01:31 Patient receives care 01:58 Medical coding 02:33 Claim creation 03:18 Claim submission and clearing house 03:48 Rejection and Denial of claims 04:19 Claim adjudication 04:57 Explain how amounts are determined 05:34 Claim outcome 05:58 ERA/835 06:36 EOB vs ERA 07:15 What happens when is claim is denied? 07:49 The complete US healthcare claims lifecycle explained 08:30 Conclusion Who should watch? This video is useful for Product Managers, Product Owners, Business Analysts, QA professionals, and beginners looking to understand the US healthcare domain. If you're preparing for a healthcare domain interview or planning to transition into healthcare IT, this video will help you understand the fundamentals. Subscribe for more videos on US Healthcare, Product Management, Business Analysis, and real-world product concepts. #ushealthcare #claimslifecycle #healthcareclaims #healthcareit #productmanagement #businessanalyst #productowner #healthcare #medicalbilling #837 #835 #healthinsurance #ushealthcareclaims