Claims adjudication and post adjudication steps

Claim adjudication is the process that every insurance payer goes through to determine how much they owe a provider based on a claim that they received.


While working through this process, the insurance payer makes one of three decisions per claim…


#To pay the claim in full


#Reduce the amount paid to the healthcare organization


#Deny the claim

Ref https://etactics.com/blog/adjudication-of-claims

Also see 

The Five Steps of the Claim Adjudication Process

https://www.linkedin.com/pulse/five-steps-claim-adjudication-process-jeanne-nicole-byers?utm_source=share&utm_medium=member_android&utm_campaign=share_via


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