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Claims Adjudication Processing

Are you faced with the constant struggle of claims management? Data Dimensions is a leader in providing claims adjudication processing. Our knowledgeable adjudicators can quickly and efficiently respond to your needs and address discrepancies promptly. We provide expert staff that you can rely on. We fight fraud to contain costs and increase productivity. This allows your employees to focus on core competencies.

Data Dimensions’ team of adjudicators are highly-trained through a comprehensive, technical training program. In addition to procedures, techniques, and judicial requirements training, our adjudicators receive training on your specific adjudication platforms. On-going training allows our professional staff to remain reliable in the ever-changing challenges of claims adjudication.

Data Dimensions understands each client has unique requirements. Allowing for flexibility, our Project Mangers work with you to create a detailed project plan, verify requirements, and determine the critical success factors to satisfy your business needs. In addition, a comprehensive communication plan is developed together to define clear communication channels. Client specific training is conducted in collaboration with our Project Managers and our operations begin with full-supervision with 100% auditing until the team-in-training becomes proficient, earning client certification.

Claims Adjudication

  • Adjudicate Entitlement
  • Identify Duplicate Claims 
  • Analyze Validity of Claim/Fraud Detection 
  • Extricate “Data Components” from Raw Claims
  • Calculate Valid Claim Amount 
  • Establish Medical Service Provider Type 
  • Validate Data Against Adjudicating Engine
  • Commit Fully Adjudicated Claims

Outsourcing your claims adjudication processing provides you with: 

  • Highly-trained staff with superior service levels, proven processes and best practice techniques
  • Flexibility to customize training to your system requirements
  • HIPAA compliance and protection
  • Guaranteed accuracy and turnaround times
  • Accelerated growth opportunities