Claims Adjudication

By relying on your own team, are you unable to accomplish quick adjudication? Is the backlog in claims threatening your productivity? By processing claims with erroneous data, are you losing your competitive edge? Put an end to your problems by hiring us to handle your healthcare claims adjudication.

With precise and complete healthcare claims adjudication solutions, you may expedite claims execution and reduce the risks that have an influence on your earnings. To combat fraud, promote productivity, and generate income, we have certain protocols. We shall carefully review the claims record, whether manual or electronically filed, to guarantee correctness in patient names and diagnostic codes, and process claims that are legitimate and reimbursable. Our teams of skilled medical claim examiners have decades of combined expertise in the manual and automated adjudication of claims.

We provide complete services for medical claim adjudication. We decide medical claims using,

• Determination of benefits
• Verification of provider details
• Detection of fraudulent claims
• Ensuring correctness of raw claims data
• Performing rule-based edit
• Eligibility Checking
• Verification for duplicate claims
• Recommendation of changes to rejected claims

Among the most common types of claims we handle include, but are not limited to:

• HCFA 1500 / CMS 1500
• Dental Claims
• Enrollment Forms Processing (EFP)
• Miscellaneous (Complex / Non-standard)
• UB92/UB04
• Pends / Correspondence
• Vision Forms

In addition to processing the aforementioned claims, we also have the capacity and the necessary capabilities to provide our clients the relevant services listed below:

• PPO Repricing
• Forms Processing
• Insurance Fraud Detection
• EDI Integration