Work with a Claims Management Expert
Claims adjudication, also known as medical billing advocacy, refers to the process by which an insurance company reviews a claim and either settles or denies it after due analysis and comparisons with benefit and coverage standards. The claims adjudication process begins with the receiving of the claim, either directly from the policyholder or through the healthcare provider. Once the process is completed, the insurance company pays the claimant and/or provides a letter to the claimant describing the company’s decision to accept or reject the claim, as well as the reasons for doing so, known as an Explanation of Benefits (EOB).
Some of the major claims we adjudicate are Dental Claims, EFP, CMS 1500, Vision Forms, and so on. Our healthcare claims adjudication services are designed to end fraudulent claims, prevent cost overruns, and add time throughout the day to focus on other core competencies. AnnexMed has the best team of medical claim examiners who understand the adjudication framework rules. Our team with decades of experience in electronic and manual adjudication will adjudicate claims at record speed and will check for duplicates, errors, and other discrepancies that result in delays or denial of claims.
Claims Adjudication capabilities include:
- Automated & Manual claim review
- Flagging of suspicious claims at all levels
- Verification of Duplicate Claims
- Remittance Processing & Payment determination
- Eligibility Checking
- Recommendation of changes to rejected claims
- Delivering 98% Accuracy Rate
- Detection of False Claims
- Cost avoidance & recovery
- Timely & accurate disbursal
- Automatic Claims Review
- Uncovering fraud, waste, and abuse