Maven Healthcare - A Medical Billing & Coding.
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    • Company Overview
    • Why Maven?
    • What we do?
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    • Medical Billing
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    • Medical Claims Processing
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    • Medical Coding
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    • Ancillary Healthcare Services
      • Eligibility Verification
      • Referrals Request
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    • Medicare RAC audits
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    • PPO Health Insurance Claims Repricing
    • Claims Adjudication Services
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Claims Adjudication Services

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  • Claims Adjudication Services

Claims adjudication process can affect the revenue of insurance providers if it is not streamlined with a structured process. Settling claims is equally important as gaining new clients. Even genuine claims when managed in an improper manner can backfire. Insurance providers and third party administrators come across fraudulent claims and duplicate claims frequently.

Insurance organizations are often swamped with unprocessed claims and an enormous amount of resource is required to manage them fruitfully. Outsourcing the claims adjudication services is the best way to improve your operational efficiency and to make quantifiable impact in quality.

Maven Healthcare provides high-quality global claims adjudication services to insurance providers as well as third party administrators. We understand that medical claims adjudication is a hard nut to crack and improper claims can lead to duplicated claims, unwanted claims, and delayed execution.

Our approach and expertise


We at Maven Healthcare adopt a straightforward approach towards claims adjudication services with a team of healthcare professionals trained on multiple adjudication platforms and plan design. Our certified adjudicators are skilled analytical problem solvers with stellar knowledge in medical terminology.

Our structure


Maven Healthcare’s experienced claims adjudicators work on comprehensive software platforms and are flexible in adjudicating claims payment either through client’s payment system or our own claims system. We realize the significant effect claims adjudication has on the claims processing. Claims payment and re-pricing is a critical process and claims adjudicators are the ones to garner the best outcome out of it.

Duplicate claims


Intentionally or unintentionally, service providers sometimes submit multiple claims. Using our proprietary system and client based software, we find matching algorithms and identify duplicate claims. We segregate claims that should be bundled and unbundled. We identify incorrect coding, incorrect entries and incorrect diagnosis as well. This way we streamline your claims adjudication process.

Maven Healthcare’s claims adjudication services

  • Eligibility.
  • Checking of duplicate/fraudulent claims.
  • Review of diagnosis, coding, and bundling.
  • Analysis of details of hospital.
  • Benefit determination adjudication.
  • Rule-based edits.
  • Recommendations.

Claims types we adjudicate

  • HCFA 1500 / CMS1500
  • UB92
  • UB04
  • Dental Claims
  • Medicaid
  • Super bill
  • Medicare
  • Miscellaneous (complex / non-standard)
  • Pends / Correspondence
  • Enrollment Forms Processing (EFP)
  • Vision Claims.

Related services offered at Maven Healthcare

  • Claims processing.
  • Forms processing.
  • PPO re-pricing.
  • Insurance fraud detection.
  • EDI integration.

Key differentiators

  • Saving cost up to 30%.
  • Focussing on core competency.
  • Improved quality.
  • Our adjudicators are specially trained in US healthcare adjudication services.
  • Up-to-date maintenance of records.
  • Quick turnaround time.
  • Stringent data security and legally binding security policies.
  • Enhanced customer satisfaction.

Contact Maven Healthcare to discuss your claims adjudication services and requirement.

  • Medical Transcription
  • Company Overview
  • Quality
  • How we do?
  • Why Maven?
  • Methodology
  • What we do?
  • Our values
  • Contact Us
  • Medical Coding
  • Medicare RAC audits
  • Referrals Request
  • Eligibility Verification
  • Credentialing
  • Document Management
  • Account Receivable Follow Up
  • Medical Billing
  • Client Testimonials
  • Hospital Billing
  • Hospital Coding
  • Medical Claims Processing
  • Healthcare Accounts Receivable Services
  • Blog
  • Pricing
  • Insurance Claims Processing
  • FAQS
  • Ancillary Healthcare Services
  • Revenue Cycle Management
  • PPO Health Insurance Claims Repricing
  • Claims Adjudication Services
  • Catherization

About Maven

Maven Healthcare is an ambitious services company specializing in Healthcare Revenue Cycle Management serving Physician groups, Hospitals, Nursing Homes, Durable Medical Equipment Supliers and Practice Management Companies.

We have an unparalleled track record for satisfaction and addition of new customers by quality delivery and complete compliance.

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Recent Updates..

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Get in Touch

Maven Healthcare
525, Northern Blvd, STE 205
Great Neck
New York – 11021
Phone : 631 – 317 – 2011
Fax: 206 – 202 – 3956
Email: info@mavenhealthcare.com

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