Concepedia

Medical Claims Processing

Medical Claims Processing is a specialized administrative procedure within healthcare management systems that involves the systematic review, validation, and adjudication of claims for medical services rendered, distinguished by its focus on accuracy, regulatory compliance, and reimbursement coordination between providers and payers.

226

Publications

14K

Citations

1.1K

Authors

443

Institutions

Publications per year

2017–2026

59

Parents

Children

Publications

226

Discordance of Databases Designed for Claims Payment versus Clinical Information Systems: Implications for Outcomes Research

James G. Jollis · Annals of Internal Medicine · 1993 · 633 citations

, , +17

Accuracy of administrative databases in identifying patients with hypertension.

Karen Tu, Norman R.C. Campbell, Zhong‐Liang Chen et al. · PubMed · 2007 · 536 citations

, , +12

Accuracy of medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records

Yuka Kiyota, Sebastian Schneeweiß, Robert J. Glynn et al. · American Heart Journal · 2004 · 525 citations

, , +12

Care Patterns in Medicare and Their Implications for Pay for Performance

Hoangmai H. Pham, Deborah Schrag, Ann S. O’Malley et al. · New England Journal of Medicine · 2007 · 515 citations · Full text

, , +17

An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With an Acute Myocardial Infarction

Harlan M. Krumholz, Yun Wang, Jennifer A. Mattera et al. · Circulation · 2006 · 498 citations · Full text

, , +17

1–5 of 226

Authors

1.1K

  1. SS
    Susan S. Huang

    University of California, Irvine, United States

    6 publications · 189 citations

    6

    h-index

  2. DW
    Dale W. Bratzler

    Oklahoma Foundation for Medical Quality, United States

    5 publications · 179 citations

    5

    h-index

  3. AM
    Allen Ma

    Oklahoma Foundation for Medical Quality, United States

    5 publications · 179 citations

    5

    h-index

  4. AE
    Anne Elixhauser

    Agency for Healthcare Research and Quality, United States

    4 publications · 126 citations

    4

    h-index

  5. CY
    Clifford Y. Ko

    University of California, Los Angeles, United States

    4 publications · 389 citations

    4

    h-index

1–5 of 1.1K

Institutions

443

  1. Harvard University

    Cambridge, United States

    16 h-index

    90 publications

    8K citations

  2. Brigham and Women's Hospital

    Boston, United States

    15 h-index

    55 publications

    3.7K citations

  3. RAND Corporation

    Santa Monica, United States

    10 h-index

    26 publications

    1.5K citations

  4. Wilmington University

    New Castle, United States

    8 h-index

    27 publications

    709 citations

  5. University of Washington

    Seattle, United States

    8 h-index

    19 publications

    527 citations

  6. Massachusetts General Hospital

    Boston, United States

    8 h-index

    15 publications

    511 citations

  7. University of California, Los Angeles

    Los Angeles, United States

    7 h-index

    29 publications

    2.3K citations

  8. University of Alabama at Birmingham

    Birmingham, United States

    6 h-index

    27 publications

    2.3K citations

1–8 of 443

Venues

  1. Medical Care

    20 publications · 1.5K citations

    17

    h-index

  2. PubMed

    Repository · 11 publications · 928 citations

    10

    h-index

  3. Journal of Clinical Epidemiology

    6 publications · 925 citations

    6

    h-index

  4. Infection Control and Hospital Epidemiology

    ICHE · 5 publications · 172 citations

    5

    h-index

  5. PLoS ONE

    5 publications · 267 citations

    5

    h-index

1–5