Claims adjudication is the process of reviewing claims received and either settling or reducing, or denying them after due analysis and comparisons by Insurance companies. After a medical claim is submitted, the insurance company determines its financial responsibility for paying the provider.
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, processes claims with 95% auto-adjudication.
HOMs unique platform gets you the best coverage, considers all the additional expenses or exceptions across states, and customizes claims submissions.
Our technology enables seamless operations and improves procedural efficiency reducing processing time by up to 50% and resulting in higher satisfaction.
A robust system to collect, track and maintain data through the latest technology and infrastructure.
All verification and legitimization processes comply with NCQA, URAC, and JCAHO standards.
Highest productivity and quality standards with competitive pricing.
Secure storage of all documents on the client’s server, less chance of a breach.
More acquainted with payor requirements for the credentialing.
Importance of Claims Adjudication
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 disbursal to the insurer. Timely disbursal would also ensure the growth or acceptance of health benefits and propagate the importance of healthcare to the people.
Adherence to CMS regulations.
AI-powered, state-of-the-art claims processing portal.
Checking data accuracy with claims adjudication engine.
Easy-to-use, easy-to-integrate with third-party gateways.