Should you consider outsourcing medical claims adjudication?

Should you consider outsourcing medical claims adjudication?
Medical claims adjudication can be an intricate, costly process, and if your organization is struggling with its complexities, outsourcing your adjudication duties could be the solution you’re looking for.


Here’s what the medical claims adjudication process involves:

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

The provider you choose should have an expert staff that will help your company fight fraud, increase productivity and free your employees up to focus on your firm’s core competencies. The provider should also offer superior service levels, the flexibility to customize training to suit your system requirements, guaranteed accuracy and turnaround times, accelerated growth opportunities and, of course, HIPAA compliance and protection. Finding such a provider will be the key to your organization finding success in medical claims adjudication.


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