The depth model
The depth model
The same lesson, published at three depths. Depth is a property of a lesson rather than a separate lesson: adding L2 to an existing L1 lesson is an additive diff — no URL change, no re-enrolment, no progress reset.
Anatomy of a claim, end to end
45 min · MI-05, MI-06, MI-13
What a claim is
A claim is a formal request for payment, sent by a provider to a payer after a service has been delivered. At heart it is a data document: every field answers a question the payer needs settled before it will agree to pay.
A claim that arrives complete and correct on the first attempt is called a clean claim. That label is not a compliment — it is an operational measure. Every claim that is not clean means rework and delayed collection.
A claim that passes the payer's edits on the first submission, with no correction and no request for further information.
Training example: a claim for procedure PRC-1042 with diagnosis DX-A118 arrives with every field complete and matching the member card.
An intermediary that receives claims from providers, checks their format, and routes them to the correct payer.
| Aspect | Self-pay | Insured |
|---|---|---|
| Who is billed | The patient | The payer, then the patient for any balance |
| When money arrives | At the visit | After adjudication, often weeks later |
| What can go wrong | Non-payment | Rejection, denial, underpayment, or delay |
| Document produced | A receipt | A claim, then a remittance advice |
- RegistrationMember and coverage details are captured.
- Eligibility checkCoverage is confirmed as active for the service requested.
- Service deliveryThe service is delivered and documented in the record.
- CodingDocumentation is translated into procedure and diagnosis codes.
- Claim assemblyThe required fields are assembled into one document.
- SubmissionThe claim is sent through the clearinghouse.
- AdjudicationThe payer decides to pay, deny, or reduce.
- RemittanceA statement arrives explaining what was paid and why.
- Posting and follow-upPayment is posted and any shortfall is worked.
Key takeaways
- A claim is a data document; each field answers a question the payer needs settled.
- A clean claim passes the payer's edits on the first attempt.
- The lifecycle has nine stages, and each one produces a traceable artefact.