Claims and Adjudication
Improved turnaround time.
Reduced costs.
With 99%+ accuracy, a turnaround time of 24 hrs, and gap identification, we help in timely payments and reduced costs.
Glossary
Claims Adjudication
Claims adjudication is the process of reviewing claims received and either settling or reducing, or denying them after due analysis. After a medical claim is submitted, the insurance company determines its financial responsibility for paying the provider.
Our EDGE
Experience. Expertise. Execution.
Adherence to CMS and state regulations.
AI-powered, state-of-the-art claims processing portal, reducing total costs.
Checking data accuracy with claims adjudication engine.
Ensuring accurate and timely payments.
Single point of contact for all client deliverables ensuring smooth processess.
Easy to use, easy to integrate with third-party gateways.
Importance of Claims Adjudication
Why Claims Adjudication is important?
Detection of False Claims
Proper adjudication ensures that set procedures and checks are followed, ensuring that no false medical claims are approved for the financial benefit of any individual.
Right Claim Value
Adjudication guarantees that each medical claim is correctly analyzed, and its proper value, based on the type of insurance and documents, disease, and other related reports to adjudicate the exact claim value.
Timely Disbursal
Proper and just medical claims adjudication process ensures that the correct claim amount is timely disbursed to the payer. Timely disbursal would also ensure the growth or acceptance of health benefits and propagate the importance of healthcare to the people.
Proper adjudication ensures that set procedures and checks are followed, ensuring that no false medical claims are approved for the financial benefit of any individual.
Adjudication guarantees that each medical claim is correctly analyzed, and its proper value, based on the type of insurance and documents, disease, and other related reports to adjudicate the exact claim value.
Proper and just medical claims adjudication process ensures that the correct claim amount is timely disbursal to the payer. Timely disbursal would also ensure the growth or acceptance of health benefits and propagate the importance of healthcare to the people.
up to
95%
Clean Claims Rate
up to
99% +
Claims Adjudication Quality
up to
99% +
Payment Accuracy
24hrs
Turn Around Time
Qualified team of adjudicators with
55+
years of consolidated
experience
Why HOM
Improve procedural efficiency.
Efficient operations
HOM’s operational efficiency and service delivery ensure your claims processing remains an important area of focus.
Prioritized claims disputes
Our AI-powered software prioritizes claims disputes and streamlines them to ensure positive revenue flow. Our claims portal, ideal for HMOs and Medicare Advantage plans, processes claims with 95% auto-adjudication.
Comprehensive claims review
HOMs unique platform gets you the best coverage, considers all the additional expenses or exceptions across states, and provides comprehensive claims review, timely payments, and accurate disbursals.
HOM’s operational efficiency and service delivery ensure your claims processing remains an important area of focus.
Our AI-powered software prioritizes claims disputes and streamlines them to ensure positive revenue flow. Our claims portal, ideal for HMOs, Medicare Advantage plans, processes claims with 95% auto-adjudication.
HOMs unique platform gets you the best coverage, considers all the additional expenses or exceptions across states, and provides comprehensive claims review, timely payments, and accurate disbursals.
We would like to hear from you!
If you have any questions, comments, or feedback, please don’t hesitate to reach out to us. Our team is ready to assist you in any way we can.