Pre-adjudication & Post-adjudication in medical claims - RCM

Pre-adjudication is the process of “cleansing” or “scrubbing” claims before they are submitted to the claims adjudication system for processing for the first time. This is intended to increase the first-pass-rate (the chance of adjudicating correctly during the first pass) and reduce manual intervention.


Post-adjudication is the process of accepting claim files that are pending, identifying and prioritizing the claim header and line-level pend or deferral codes, and subjecting the claim to the appropriate business rules to repair the pend code with the highest priority.

 

Comments

Post a Comment

Popular posts from this blog

C programming - basic memory management system with leak detection

This reconstructed code implements a basic memory management system with leak detection. Here's an explanation of the different parts: 1. `MemoryNode` structure: This defines a node in a linked list that tracks memory allocations. Each node contains a pointer to the allocated memory, its size, and a pointer to the next node. 2. `custom_malloc` function:    - Handles zero-sized allocations by returning NULL.    - Allocates memory using the standard `malloc`.    - Creates a new `MemoryNode` to track the allocation.    - Adds the new node to the front of the linked list. 3. `custom_free` function:    - Traverses the linked list to find the node corresponding to the pointer being freed.    - Removes the node from the list and frees both the allocated memory and the tracking node.    - If the pointer is not found in the list, it prints an error message. 4. `check_leaks` function:    - Traverses the linked list of...
Read more

Fresher can certainly do freelancing - can land you a decent full time job in time

Fresher can certainly do freelancing, and there are many STEM (Science, Technology, Engineering, and Mathematics) skills that are feasible for freelancing, even without prior work experience. Freelancing can be an excellent way to gain experience, build a portfolio, and earn income while working on projects related to your field of interest. Here are some STEM skills that can be suitable for freelancing: 1. Web Development: If you have skills in HTML, CSS, JavaScript, and web development frameworks like React or Angular, you can offer web development services to clients looking to build or maintain websites. 2. Graphic Design: Graphic design skills, including proficiency in tools like Adobe Photoshop or Illustrator, can lead to freelancing opportunities in creating logos, marketing materials, and digital artwork. 3. Content Writing: Strong writing skills can be leveraged for freelance content writing in various STEM niches, such as technology blogs, scientific articles, or software doc...
Read more

"Enterprise GPT: A Game Changer", Roadmap for professionals to develop the required skills for such jobs

 "Enterprise GPT: A Game Changer", Roadmap for professionals to develop the required skills for such jobs Enterprise GPT: A Game Changer Introduction: The integration of Generative Pre-trained Transformers (GPT) into enterprise environments is revolutionizing the way businesses operate, communicate, and innovate. This article explores the transformative impact of Enterprise GPT, using Boston Consulting Group (BCG) as a prime example, and provides a roadmap for professionals to navigate this AI-driven landscape. 1. BCG's Enterprise GPT Strategy BCG's approach to Enterprise GPT serves as a model for other organizations: a) Universal Access:    - Rolled out to every employee, democratizing AI capabilities    - Ensures data security by keeping information within BCG's control b) Customization:    - Consultants can build tailored GPTs for specific engagements    - Over 3,000 GPTs created, addressing various tasks c) Efficiency Boost:    ...
Read more