Put an End to Inaccurate Claims by Outsourcing Claims Adjudication

Are inaccurate claims taking its toll on the financial health of your hospital or healthcare facility? Now you can put a full stop to such setbacks by outsourcing claims adjudication services to India. You can leverage benefits such as, accurate claims, fewer re-works and streamlined processes, apart from significantly bringing down your claims adjudication costs by a whopping 30- 40%. Outsourcing will put your hospital in touch with skilled claims adjudication experts who can assure you of exceptional financial accuracy when it comes to processing your claims.

Within a few weeks of outsourcing claims adjudication, you can be sure to witness an increase in your overall efficiency and a drastic reduction in costs. With claims adjudication out of your hands, you will not have to invest on expensive technology, infrastructure or software, as your service provider will be providing you with these.

Benefits of Outsourcing Claims Adjudication

Apart from saving on cost, you can also take advantage of the other benefits of outsourcing, such as:

  • Put an end to lost claims
  • Enjoy flexibility on volume fluctuation
  • Experience faster processing and payment
  • Get access to multi-site redundancy
  • Save on the trouble of hiring and then training a team of in-house claims adjudicators
  • Get all your claims accurately processed within a short turnaround time (12 to 24 hours)
  • Tap into the expertise of professionals who have vast experience in healthcare claims adjudication
  • Get your claims adjudicated on your own payment system of on the system of the service provider

Types of Claims That Can Be Adjudicated

Experienced healthcare service providers like Outsource2india have years of experience in processing claims for large insurance carriers and third party administrators. With skilled claims adjudicators and trained IT professionals, a service provider like Outsource2india can efficiently process and adjudicate any type of claim, such as,

  • CMS1500/ HCFA1500
  • Enrollment forms processing (EFP)
  • Miscellaneous claims (complex / non-standard)
  • Dental claims
  • Correspondence / Pends
  • Vision forms
  • UB92/UB04

6 Step Claims Adjudication Process

You need not have any concerns about the accuracy of your claims, as your outsourcing service provider will generally follow a proven six step process, such as the following:

  • The eligibility of the claim will be checked
  • Duplicate claims will be checked
  • The claims will be coded and bundled. A diagnosis review will be conducted
  • The hospital details will be checked and analysed
  • Benefit determination adjudication will be carried out
  • Rules-based edits will conducted on the claims

Tap Into the Skills of Expert Claims Adjudicators

Outsourcing can put you in touch with expert claims adjudicators, who have the following skills:

  • Proficient claims adjudicators who are trained on multiple platforms and plan designs
  • Healthcare professionals with a vast knowledge of medical terminology and who are great analytical problem solvers
  • Dedicated claims adjudicators who are trained on the latest U.S. healthcare processes and claims adjudication systems

Before working on your assignment, each claim adjudicator will be rigorously trained on your unique requirements and processes.

How to Outsource Claims Adjudication?

When you approach a service provider in India for claims adjudication services, the process will be as follows:

  • A team of certified claims adjudicators will go through an extensive training program to understand your insurance plans, systems and claim types
  • The service provider will work with you to come up with a detailed project plan, after thoroughly verifying your requirements and evaluating the success factors that need to be met
  • A comprehensive communication plan will be created to define the communication channels that will be used to review the status, issues and amendments during the claims adjudication process
  • A dedicated Project Manager will be assigned to manage the entire project, right from the start to the finish
  • The claims adjudication process will begin

Contact us to start outsourcing claims adjudication services.

Interested to know more?

The following two tabs change content below.

Leave a Reply

Your email address will not be published. Required fields are marked *


+ four = six