Advanced Medical Claim Adjudication Services

Realize higher payments with accurate claims processing services



Boost Your Claims Settlement Process with Advanced Offshore Medical Claim Adjudication Services

Achieving fast and accurate adjudication of medical claims requires careful consideration of several variables, and the process can weigh heavily on your resources. For your practice to be running smoothly, the claims adjudication process must be efficient and handled by experts. Instead of spending hours sifting through codes and regulatory guidelines, you can give your business a productivity boost by partnering with MedbillingExperts for all your medical claims adjudication requirements. While your clients work on providing accessible healthcare to your patients, we ensure the health of your claims.

At MedBillingExperts, we provide digitized healthcare claims adjudication services to insurance providers as well as third party administrators to boost their productivity and revenue flow. Our expertise spans across several years of dedicated service helping clients with the complete medical billing cycle. Armed with a team of highly skilled adjudicators, we leverage our abilities to help our clients optimize their existing procedures, automate their analysis, and realize a secure digital workflow. Our client-centric processes handled by a diligent workforce create the most reliable medical claims adjudication service that can be customized as per the needs of your business. This not only addresses the concerns of claims backlog and fraud but also gives your businesses the much needed competitive edge in the market.

video for medical billing services

Our Proven Claims Adjudication Services Promise Healthy Returns

  • Accurate analysis of the validity of claims to detect fraud and identify duplicate claims to prevent revenue loss.
  • Validation of data against adjudicating systems and computation of the valid claim amount for profitable collections.
  • Machine-assisted adjudicated claims process with result-driven project plans tailored to your needs.
  • Process transparency for enhanced collaboration with our clients; client-specific training for operational excellence.
  • Compliance with HIPAA regulations and ever-changing guidelines for the maximum security of confidential information.

Our End-to-end Healthcare Claims Adjudication Process Works the Way Our Clients Need It To

Eligibility
verification

Verify insurance coverage to determine patient eligibility for guaranteed reimbursements

Verification of Fraudulent/ Duplicate claims

Review claims to root out the existence of fraudulent or duplicated claims

Coding, Bundling, and Diagnosis Review

Break down diagnostic and treatment codes for separate procedures

 

Detailed analysis of provider

Thorough analysis of insurance policy and provider’s payment responsibilities

Benefit determination

Evaluate claims for determining the benefit covered under the insurance policy

Appeals processing

Manage denials and process claim reimbursement appeals; recommendations for analytical solutions

 

Our End-to-end Medical Claims Adjudication Services

Initial Processing Review

Our multi-layered medical claims adjudication outsourcing service starts with an initial processing review where we check the claims for simple errors and omissions that can lead to significant costs if left undetected. As a provider of claims adjudication service in USA, our review process pays special attention to verifying patient identity and eligibility to ensure that any missing data is immediately acquired for generating a complete claim. During the review, our team ensures that the data provided in the claim documents can be verified and backed by original source documents .

Patient Scheduling and Registration
claim adjustication service

Check Claim Authenticity

As part of our multi-layered outsource claims adjudication services, our experts go over the more intricate matters of the claim pertaining to the insurance payer's payment policies. This involves checking if the insurance coverage is active, followed by ensuring that the diagnostics and procedure codes match the codes listed on the claim. The automatic review system also roots out issues such as duplicated claims, filing of claims well after the deadline, and other types of fraud.

Pre-certification Verification Review

Our automatic review process also evaluates pre-certification or authorization records to identify cases where there is an absent or invalid pre-certification issue. Such cases are liable to take place when the diagnosis, procedure, or the date of service cannot be correlated to the information provided in the pre-certification or authorization. Another scenario that our automatic review process deftly identifies is when the authorization number that was required for a particular service was not obtained or added to the claim before the submission.

claim adjustication pre-certification
claim adjustication manual review

Manual Review

Our claims examiners carry out a cross-verification of the claims for evaluating their authenticity. This helps to rule out cases where unlisted procedures were implemented on patients despite not having medical necessity. For this, we adhere to a meticulous review process that concludes upon verifying if every necessary document is in the required order for the claim to be processed successfully. This helps our clients avoid delays and denials by significantly shortening the otherwise lengthy claims management process.

Payment Determination and Adjustments

As a claims adjudication outsourcing service company, we provide analytical support in the claims payment determination process as well. While our services have been designed to ensure a reduction in denied claims, we provide continued support in processing claims that are considered paid, as well as reduced claims. Our analytical support solutions offer the correct adjustments that should be made for accurate reimbursements. We also offer precise root cause analysis of denied claims to identify errors that can be identified and prevented in future claims. .

claim adjustication payment determination
claim adjustication appeals processing

Appeals processing

In cases where there are discrepancies between the claim and the policy, our medical claim adjudication team provides support during the appeal process. We are fully equipped to handle the complexities of the process and adjust our workflow according to the specific rules governing the appeals process. Our efficient appeals processing services ensure that care providers receive proper and adequate reimbursements for their services. As the appeal process can be long and arduous, we strive to help our clients in filing clean claims from the very beginning.

Our Specialties

What Sets Us Apart from Our Competitors in Medical Claims Adjudication

Reliable and Quality Services

As a reputed claim adjudication services company, our service processes have been crafted to surpass the industry benchmarks in all areas of medical claims processing.

Quick Turnaround Times

We use automated and integrated systems to ensure efficient process handling and reduced turnaround times for optimum outcomes.

Cost Savings

Our efficient and automated work-process reduces your operational overheads and ramps up claim reimbursements while decreasing denials.

Fewer Administrative Tasks

Our seasoned professionals cut down on your tedious administrative tasks and enable your team to focus on its core activities.

Data Security

Our security measures include wireless networks, firewall VPNs, encrypted software, and SSLs to safeguard your data from all types of fraud and losses.

Thorough Compliance

We maintain complete compliance with HIPAA regulations in all our documentation practices throughout the process.

Here’s What Our Clients Have to Say About Us

Kavitha CEO, CHPPS (CA)

Our experience with MBE resulted in a successful long-term relationship from which we have benefited substantially. Our A/R has seen a marked increase during the collaboration and our billing process has become significantly smoother. The overall rate of denials has also decreased remarkably, giving us the incentive to continue with MBE as our go-to claims adjudication service company. Our administrative overheads have reduced drastically, giving key members of our organization the scope to focus on more pressing concerns. We appreciate the support and services of MedBillingExperts in our journey together.

James Godfrey CFO Chiropractic Practice (New Jersey)

"The smoothest experience we have ever had with an external firm for claims adjudication service in USA. MBE is a group of true professionals who do everything they can to honor their end of the agreement. The collaboration has been a terrific success with our billing and reimbursements becoming markedly easier to execute. We look forward to doing more business with the enthusiastic claim adjudication services company over the years to come."

Medical Claims Adjudication Through Our Lens

Our Complete Claims Adjudication Process Exposed

Our Process

Our Complete Claims Adjudication Process Exposed

A close look at how our claims adjudication process empowers insurance providers and third-party administrators to deliver exceptional service to clients while enjoying higher revenue.

How It Works
Benefits of Electronic Claims Processing for Healthcare Industry

Articles

Benefits of Electronic Claims Processing for Healthcare Industry

Get insights into how digital tools help in processing claims faster to reduce operating costs and clock impressive revenue figures.

View Our Infarticlesgraphics
How to Verify Patient Insurance in Three Easy Steps?

Blog

How to Verify Patient Insurance in Three Easy Steps?

A list of 3 handy tips for successfully verifying the insurance coverage of patients and the benefits of outsourcing insurance eligibility verification services.

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Clear Backlogs by Improving Claims Processing Efficiency

Case Study

Clear Backlogs by Improving Claims Processing Efficiency

Our customized solution helped a California-based medical billing company to clear backlogs three times faster than the original pace.

Read Our Case Study

FAQ's on Claims Adjudication Outsourcing Services

With respect to medical billing, adjudication is the term used by the industry to describe the process of evaluating a claim for the payment of benefits. The adjudication process determines whether the claimed amount falls within the coverage of the patient’s insurance policy. The adjudication process involves several steps that can be carried out smoothly by providers of outsourcing claim adjudication services.

The adjudication process can be broadly broken down into the following five steps: initial processing review, followed by automatic review, manual review, payment determination, and payment. An expert understanding of these steps enableshealthcare claims adjudication services to generate, submit, and follow-up on claim processing. This leads to maximum reimbursement generation for medical service organizations.

For successful medical billing, regular follow-ups with the concerned stakeholders are essential. For medical claim follow-ups, relevant questions regarding the status of the claim should be asked and the answers documented for future reference by the claim’s adjudication services in the USA. It is necessary to have a clear understanding of the status of the claim and the reasons behind claim denials (if any). Frequent follow-ups can ensure that a claim goes through faster.

As a leading provider ofclaims adjudication outsourcing services, our charges vary per read depending on the requirements of our clients. Our pricing structure is not rigid and can be customized to meet our client’s demands. Our general pricing structure accommodates per read, while our Full Time Equivalent Model can be availed at around $1300 to $1800 per FTE per month. The prices may vary depending on the services availed. Our competitive rates can ensure up to 40% savings in our clients’ expenses.

Electronic claims are nothing but electronically submitted claims for the rendering of medical services. For the submission of electronic claims, relevant CPT codes need to be identified from the ICD-9-CM or ICD-10-CM databases during filing. This information is submitted as an ANSI 837 file. The electronic aspect of the claim makes it easier to process and also ensures fewer errors in submissions. It is important to have sufficient knowledge and understanding of the procedure for filing electronic claims, and claims adjudication service companies can be of great help in this regard.

Our claims adjudication services require anywhere between a few days to a couple of weeks to start off, depending on the specific requirements of our clients. As our services are customizable, the time to get started can vary from client to client. Our team of professionals strives to make a significant difference to our client’s adjudication management within a few weeks of setting up.

At MedbillingExperts, we leverage our 10+ years of industry experience to provide the best of medical claims adjudication services to our clients. Our team of certified experts and HIPAA compliant claims adjudication processesensure that our clients receive the best services at competitive rates. As a leading outsource medical claims adjudication services provider, we excel in ensuring that the clients’ claims adjudication process sails through with ease.

MedBillingExperts can be contacted through the phone as well as an email with a guaranteed response within 24 hours. Our team of professionals is available 24*7 to provide expert billing solutions and advice wherever necessary. We strive to deliver quality services to our global clients, ensuring that time zones do not serve as hurdles in the way of our service.

FAQs on Revenue Cycle Management Services

97%

Clean Claims On First Submission

24/7

Support

100%

HIPAA Compliance

25%

Increase in Collections

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Our Software Expertise

Software Tools We Use for Medical Billing and Coding Solutions