Page 21 - C.Journal 3rd edition

Claims Journal 3rd Edition Claims Journal 3rd Edition

Technical Corner Technical Corner

Claims Control Unit (CCU) – Work Process- Part 1

Definition of Terms CCU Mail Center

1.Claims Control Unit (CCU) – responsible for receiving & registering all physical claims from Core Service
the providers, preparation for processing & distribution including filing and archiving. Receives all physical documents originating from providers via couriers or direct mail related to
claims processing. Average number of claims received daily is around 40,000 to 60,000 claims de-
2.General Summary Statement (GSS) – official document detailing financial summary of pending on peak days of the month.
claims submitted to Bupa for processing.
Key documents:
3.Electronic Data (E-Data) – financial or medical data in excel sheet reflecting the information 1.Provider Claims (comes in boxes/cartons, box files, pouches, envelopes etch.)
from the physical claims submitted by the provider. 2.General Summary Statement (GSS)
3.E-Data in CD, Floppy Disk or USB
4.Provider Group Statement (PGS)
Process Work Flow
Tools:
1.Provider Claims Registry
2.Batch Tag
3.Scanned GSS (for reference)

Head count (3):

1.Mail Center In-Charge – registers and maintains all pertinent details related to received provider
claims in a registry sheet.
2.Assistant Officer – assists in registry including immediate retrieval of GSS for prompt payment
processing.
3.Support Officer – manual support in preparation of claims before it’ forwarded to distribution
team.

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