If you are an insurance company then the term “Adjudication” is no jargon for you. Yet, to put it forth more clearly; it is the legal process by which an arbiter or judge reviews evidence and argumentation including legal reasoning set forth by opposing parties or litigants to come to a decision which determines rights and obligations between the parties involved. Adjudications contribute in resolving 3 types of disputes:
- Disputes between private parties, such as individuals or corporations
- Disputes between private parties and public officials
- Disputes between public officials or public bodies
The adjudication process consists of receiving a claim from an insured person and then using software to process the claims and make a decision or doing so manually. If it’s done automatically using software or a web-based subscription, the claim process is called auto-adjudication. Automating claims often improves efficiency and reduces expenses required for manual adjudication. Many claims are submitted on paper and are processed manually by insurance workers.
After the claims adjudication process is complete, the insurance company often sends a letter to the filer describing the outcome. The letter, which is sometimes referred to as remittance advice, includes a statement as to whether the claim was denied or approved. If the company denied the claim, it typically has to provide an explanation for the reason why under regional laws. The company also often sends an explanation of benefits that includes detailed information about how each service included in the claim was settled. Insurance companies will then send out payments to the providers if the claims are approved or to the provider’s billing service.
You understand that claims payment and reprising is a very difficult process, and that results are better garnered when these are handled by experts dealing with adjudication day in and day out. It is for that exact reason that we build our Insurance Payer Services team based on industry experience and proven results. Our team goes through a rigorous training on the claims adjudication process. We believe in educating our adjudicators and then training them on simulated claims so they can adjudicate payments from day one of a project using our client’s payment system or our own proprietary claims system.
Futuristic Giga Tech Services’ delivers exceptional financial accuracy with fewer re-works, streamlined processes & significantly reduces adjudication costs. We enhance your claims adjudication capacity by providing access to highly skilled labor and proven processes.
- Benefit Analysis
- COB Edits
- Stop Loss Claims
- Flexibility on Volume Fluctuation
- Faster Processing
- Multi-site Redundancy
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