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.
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.
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
- Checking of duplicate/fraudulent claims.
- Review of diagnosis, coding, and bundling.
- Analysis of details of hospital.
- Benefit determination adjudication.
- Rule-based edits.
Claims types we adjudicate
- HCFA 1500 / CMS1500
- Dental Claims
- Super bill
- 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.
- 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.