HEALTHCARE CLAIMS ADJUDICATION SERVICE

Are you unable to meet deadlines by relying on internal resources? Is your productivity being harmed as a result of a claims backlog? Are you squandering your competitive advantage by processing claims based on false information? ExbroIT’s claims adjudication services will put an end to your problems right now. With our claims adjudication services, we’ve increased our efforts to combat fraud, promote productivity, and increase income.

We shall review all claims, whether they are submitted manually or electronically, to ensure that patient names and diagnostic codes are correct, and that legitimate and reimbursable claims are processed. Our medical claim examiner will scrutinize claims after they have been submitted for insurance and will reject any that are incomplete, duplicated, or incorrect. Our meticulous claims adjudication methods will help you expedite claim processing while also reducing risk to your bottom line.

Healthcare Claims Adjudication Services We Offer:
ExbroIT has teams of medical claim examiners with decades of experience adjudicating both manual and computerized claims. We work with over 500 hospitals and insurers throughout the world. We keep our knowledge base up to date through workshop sessions to stay prepared for the current difficulties that cause payment delays. Among the claims adjudication services we provide are:

1-Processing of Medical Claims
2-Encounter Processing and Medical Claims
3-Medicare Reimbursement Services Remittance Processing
4-Dental Insurance Claims Services of adjudication
5-Benefits determination
6-Verification of the provider’s information
7-Fraudulent claims detection
8-Assuring the accuracy of raw claims data
9-Applying a rule-based edit
10-Checking for Eligibility
11-Checking for duplicate claims
12-Recommendations for revisions to claims that have been denied

We Adjudicate The Following Types Of Medical Claims:
Some of the most frequent types of claims we handle are as follows:

1)1500 HCFA / 1500 CMS
2)UB92/UB04
3)Dental Insurance Claims
4)Pends / Correspondence
5)Processing of Enrollment Forms (EFP)
6)Forms of Vision
7)(Complex / Non-standard) Miscellaneous...

Apart from processing the previously mentioned claims, we also have the necessary skills, experience, and bandwidth to provide the following connected services to our clients:

1-PPO Repricing
2-Forms Processing
3-Insurance Fraud Detection
4-EDI Integration

We Follow the Healthcare Claims Adjudication Process:
We understand every form of issue that may develop in this process because of our significant experience in the healthcare insurance sector. Our team is well-versed in dealing with such issues and comprehending the complexities of the procedure in order to give effective services in a timely manner. This is made feasible by using a streamlined and systematic claims adjudication process. The steps in our procedure are outlined below –

1- Review of the Initial Processing:
The claims are extensively scrutinized for mistakes and omissions in the first step. When a claim is refused for any of the following reasons, it can be adjusted and resubmitted for payment.

1-The patient’s name is incorrect or incorrect.
2-The service code is in the wrong place.
3-The date of service is incorrect.
4-The diagnosis code is invalid or missing.
6-Wrong subscriber identification number or incorrect plan
7-Service and patient gender mismatch

2- Automatic Review:
Claims are examined in depth for things that apply to payment policies in this step. Among the flaws discovered during the automatic review are:

1-Patient eligibility at the time of service
2-Authorization and pre-certification are not present.
3-Pre-certification and invalid authorization
4-There are duplicate claims submitted.
5-The deadline for filing has passed.
6-The procedure or diagnostic code is invalid.
7-Medically, the services are not required.

3- Manual Review:
Medical claim examiners manually examine the claims at this stage. Manual checks and comparisons of medical paperwork with claims are typical practices among nurses and doctors. This stage is carried out for any type of medical operation, but it is particularly important for procedures that aren’t on the list.

4- Payment Determination:
Payment determinations are divided into three categories. They are as follows:

Paid – If the claim is deemed paid, the payer decides if reimbursement is possible.
Denied – The payer concludes that the claim is non-reimbursable if it is considered refused.
Reduced – The claims examiner can down-code to a lesser level if the billed amount is too high for the diagnosis.

5- Payment:
An explanation of payment is the payment that the insurance payer makes to the medical care provider. It contains the following information:

1-Allowed Amount
2-Covered Amount
3-Patient Responsibility Amount
4-Approved Amount
5-Payer Paid Amount
6-Discount Amount
7-Adjudication Date

Why Choose Exbroit To Handle Your Healthcare Claims Adjudication?
ExbroIT, being a major provider of healthcare BPO services to clients around the world, has the capabilities and knowledge to meet any type of client requirement. You can gain the following advantages by outsourcing claims adjudication services to us:

Affordable Services:
Our clients will be billed according to the number of claims processed per day, work volume, and other factors. This ensures that services are delivered quickly and efficiently at a reasonable cost.

Best Infrastructure:
We have a cutting-edge infrastructure in terms of world-class office spaces, an uninterruptible network, and other features that enable us to promptly provide world-class services to all of our clients.

Leverage Advanced Software:
We employ the most recent and updated versions of the most effective claims adjudication tools and technology.

Quick Turnaround Time:
We have many distribution locations located throughout the world in various time zones, allowing us to deliver results in a timely manner.

Single Point of Contact:
Assign a specialized project manager to your high-priority request. We have a full-time SPOC that can help you by relaying your questions to our adjudication staff. You will receive responses without having to wait.

Qualified Team of Adjudicators:
Our staff consists of adjudicators and insurance specialists who are highly knowledgeable, talented, qualified, and experienced in dealing with a wide range of customer needs.

Easily Scalable Services:
We have the necessary bandwidth to scale up or down the claims adjudication process according to the needs of the customer.

24/7 Availability:
When you outsource to us, we appoint a professional project manager who will be your single point of contact for all your questions and project updates through phone or email every time.

Outsource Medical Claims Adjudication Services to Us:
For over many years, ExbroIT has been a prominent provider of claims adjudication services in the USA as well as a variety of other healthcare BPO services to global clients. Our high-quality services and operational efficiency have benefited all of our clients. ExbroIT’s staff can adjudicate claims payment via the customer’s payment system or our own in-house claims system, depending on the situation. Whatever claims adjudication requirements you have, we are capable of handling them in a professional manner. Get in touch with us right away to talk about your project requirements.