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Outsource Claims Adjudication Services

Claims Adjudication Services

Claims adjudication is an important task for insurance providers as it prevents instances of duplicated claims, unwanted claims, delayed execution, etc. Even the right claims when mismanaged can have adverse effects on the company. Inefficient healthcare claims adjudication will eventually adversely affect the firm's revenue. So it is important to streamline this process by outsourcing it to a reliable service provider.

Outsource2india has been offering claims adjudication services to large insurance carriers and TPAs (third-party administrators) for over 19 years now. Our claims adjudication approach is simple - engaging a team of experienced and qualified claims adjudicators and a team of IT professionals to deliver efficient adjudication solutions to payers. We provide you with a blend of skilled resources, efficient processes, quality systems, and advanced technology, to assure exceptional quality, increased efficiency, and significant cost savings.

Claims Adjudication Services We Offer

Outsource2india has been providing global clients with high-quality healthcare claims adjudication services for almost two decades now. Being in the industry for so long, we have the required knowledge and experience to efficiently carry out claims adjudication and can cater to any type of client requests.

We understand that insurance companies are usually flooded with high volumes of unprocessed claims and they require resources to manage it successfully. Our team of adjudicators can help you manage claims in the most efficient manner. Some of the major types of claims we can help you process include, but not limited to -

  • HCFA 1500 / CMS 1500
  • UB92/UB04
  • Dental Claims
  • Pends / Correspondence
  • Enrollment Forms Processing (EFP)
  • Vision Forms
  • Miscellaneous (Complex / Non-standard)

Apart from processing the above mentioned types of claims, we also have the required skills, expertise, and bandwidth to provide our clients with the following related services -

  • Medical Claims Processing
  • PPO Repricing
  • Forms Processing
  • Insurance Fraud Detection
  • EDI Integration

Claims Adjudication Process We Follow

With extensive experience in the healthcare insurance industry, we understand each and every type of complication that may arise in this process. Our team is experienced in handling such complications and understanding process intricacies to provide efficient services within a quick turnaround time. This is possible by following a systematic and streamlined claims adjudication process. The steps involved in our process are listed here -

Eligibility  

01. Eligibility

In the first step, we check for the eligibility of the client and whether the claim can be processed or not

Duplication Check  

02.Duplication Check

Our team will check whether there are any duplicates in claims and eliminate the ones which are repeated

Coding  

03.Coding

This step involves the coding, bundling, and the detailed diagnosis review of the claim

Hospital Analysis  

04.Hospital Analysis

Our team of healthcare experts performs a complete and detailed analysis of the hospital or the caregiving organization

Benefit Determination  

05.Benefit Determination

In this step, we determine the benefits and adjudicate to check whether the claim is valid or not

Edit Details  

06.Edits

In this final step, we may make some changes to the claims based on the rules and regulations of the industry

Why Choose Us for Claims Adjudication?

Being a leading provider of healthcare BPO services to clients worldwide, we have the required skills and expertise to handle any type of client requests. Outsourcing claims adjudication services to us can help you take advantage of the following benefits -

  • Affordable Services

    All our clients will be billed based on the number of claims processed per day, work volume, etc. This assures quick and efficient services at affordable rates

  • Data Security

    We sign confidentiality agreements and have data security policies in place to ensure that all your critical data remains completely safe with us

  • HIPAA Compliance

    All our processes and services are compliant with HIPAA hence you can be assured that all the services we provide will be of high quality

  • Best Infrastructure

    We have state-of-the-art infrastructure, which enables us to quickly provide all our clients with world-class services

  • Leverage Advanced Software

    We make use of some of the latest and updated versions of the best claims adjudication tools and technologies

  • Quick Turnaround Time

    We have multiple delivery centers around the globe across different time zones, which allow us to deliver the results within a quick turnaround time

  • Qualified Team of Adjudicators

    Our team comprises of highly skilled, talented, qualified, and experienced adjudicators and insurance experts who are capable of catering to any type of client needs

Outsource Claims Adjudication Services to Us

Outsource2india is a leading company outsourcing claims adjudication services and a gamut of other healthcare BPO services to global clients for over 19 years. All our clients have benefited from our high-quality services and operational efficiency. The team at O2I is flexible in adjudicating claims payment by either using the customer's payment system or our own in-house claims system.

Whatever claims adjudication requirements you have, we are capable of taking care of your claims adjudication process needs in a professional manner. Get in touch with us today to discuss your project needs.

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