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Medical Claims Administration, Adjudication & Management

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Medical Claims are arguably the single most important data gathering aspect of any healthcare operation. critical to risk adjustment and financing integrity by providing accurate and complete claims management.

With the efficiency of our Competent In House Medical Expertise and our State of Art claims processing system, where we audit and retain all transactions for current and historic occurrence. We compare data with corresponding submissions to ensure all claims are complete representation of the services provided and Clients Claims Guidelines.

When there is risk or delay in providing timely, accurate, and complete data, our claims team will immediately identify the root issue, conduct analysis, and resolve the issue in accordance with the Guidelines and Best Practice.

With the help of tools within our Claims Management System, we are empowered to perform the primary steps of claims adjudication that a claim should reach a “finalized” (paid, denied or deferred) status.

With our Expert management, we gather, analyze, and report data to identify and take action against inappropriate utilization of services and quality of service concerns. This proactive approach to fraud, waste, and abuse, including the Coordination of Benefits savings, cost avoidance and recovery activities result in savings affiliated with health plans.

Please Feel Free to Contact Us for a Comprehensive understanding to our various steps in Claims Management & Guidelines

Our Healthcare Claims Adjudication Process –

 

  • Receive Claims Data from You
  • Check for Eligibility
  • Check to Avoid Duplicate Claims
  • Benefit Determination Application
  • Analysis of Hospital Details
  • Coding, Bundling & Diagnosis Review
  • Rules-Based Audits
  • Claims Settlement