BC Advantage - 2017 Issue 6

CLAIM ADJUDICATION PROCESS

Claim adjudication is the process used by a payer to decide if a claim should be reimbursed. Although each payer has its own multistep process for approving claims, the process is generally the same for all payers.Claim adjudication can be a quick process when a clean claim is received. "Clean" in this instance means that all the information on the claim is correct and consistent with healthcare policy. The claim adjudication process has improved because of the great advances in software and the edits created. This process collects a large amount of information, verifies it, and issues payment...

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