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What Is Claims Adjudication | Apex EDI | Apex EDI
After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider. When an insurance company decides to reduce a …
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What is Adjudication of Claims? - Definition from …
Jun 28, 2018 · Adjudication of claims is a term used by the insurance industry to describe the process of evaluating a claim for payment of benefits. During an adjudication of claims, the insurer will determine whether a particular demand for compensation falls within the coverage of the individual's insurance policy. The adjudication of a claim may involve several steps, …
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What Does "Adjudication of a Claim" Mean? | Legal Beagle
May 31, 2011 · The term, "adjudication" is a formal way of saying, "deciding" or "resolving." The process that the insurance company goes through when deciding whether it owes you money or not is called "adjudication of a claim." It begins when someone submits a claim to the insurance company and requests reimbursement, such as for payment of a fence blown …
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What is claim adjudication process?
Adjudication of healthcare claims is the key activity which actually delivers the insurance benefits to the insurer. The process is just, and ensures that the claims are rightly addressed. “Adjudication” A formal decision or judgment given by an administrative authority, court, or tribunal, in resolution of a dispute.
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Medical Claims Adjudication: What You Need To Know …
The process of paying or denying claims submitted after comparing them to the coverage or benefit requirements in the insurance industry is known as claims adjudication. The medical claims adjudication process involves a series of steps: an insured person submitting the claim, the insurance company receiving it, and then manually processing the claim or using …
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Claims Adjudication Process - How Health Insurance …
Claims adjudication Claims adjudication can be a quick process when a clean claim is received. "Clean" in this case means that all the information on the claim is correct and within the bounds of the patient's healthcare policy. When medical review is involved there's a delay waiting on staff and documentation requested to be received and reviewed.
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