The ideal outsourced claims adjudication process should include the following services:
- Adjudication entitlement
- Identification of duplicate claims
- Analysis of the validity of claim/fraud detection
- Extrication of “data components” from raw claims
- Calculating valid and accurate claim amounts
- Establishing the correct type of medical service provider
- Validating data against a reliable and accurate adjudication engine
- Committing fully adjudicated claims
Each organization has unique requirements for claims adjudication, and the right outsourcing provider will meet those needs with a highly trained staff, tested and proven processes and a strong record of best practices methodology. What’s more, the provider will offer customized training to fit your organization’s system requirements, HIPAA compliance, guaranteed service levels and turnaround times, and accelerated growth opportunities.
If you’re seeking a solution to the increased risks, increased complexity and increased expenses associated with the medical claims process, consider outsourcing your adjudication to an established, reliable provider who meets these standards.