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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