Medical Claims Adjudication

Mitigate fraud. Contain costs. Increase productivity.

Data Dimensions is a leader in providing claims adjudication processing. Our expert staff helps our customers fight fraud, contain costs, increase productivity and focus on their core competencies.

 

Our adjudicators receive comprehensive training in procedures, techniques and judicial requirements. Our adjudicators also are trained on your specific adjudication platform and receive ongoing training to ensure they remain knowledgeable on ever-changing adjudication information.

Claims Adjudication Includes:

  • Adjudicating entitlement
  • Identifying duplicate claims
  • Analyzing validity of claim/fraud detection
  • Extricating “data components” from raw claims
  • Calculating valid claim amount
  • Establishing medical service provider type
  • Validating data against adjudicating engine
  • Committing fully adjudicated claims

Data Dimensions understands each client has unique requirements. Our Project Managers 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 percent auditing until the team-in-training becomes proficient, earning client certification.

 

Our outsourced claims adjudication service provides:

  • 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