Claims Adjudication

Claims Adjudication Services

CyberHelp HealthSolution has proven experience in Insurance Claims Adjudication and employs medical claims processing softwares and methods based on HIPAA compliance. Being a reliable claims process outsourcing industry, we are committed to offering 99.9% accuracy at the claims level and ensuring that our response times comply with CMS standards. Supported by the claims adjudication system of CyberHelp HealthSolution, we manage the entire claims lifecycle, track status, and facilitate seamless communication with payor.

Our company has developed a streamlined claims adjudication process to ensure accurate reimbursement for healthcare providers. Trust us to handle your billing needs with our state-of-the-art claims adjudication system. 


Get in touch with our experts on our functional best practices that streamlines your medical billing priorities.

What We Do in Claims Adjudication Services

  • Ensure that all keyed fields will be verified if the claims are not submitted electronically.
  • Perform verification of primary insurance and audits in real-time.
  • Evaluate coverage and member eligibility.
  • Confirm the status of providers, both participating and non-participating.
  • Determine the claim filing deadline and DRG.
  • Identify corrected/duplicate/interim/final submissions.
  • Get instructions from authorization notes and apply authorized status to claims.
  • Use appropriate adjustment/remark codes and analyze the correct allowable.
  • Ensure that coinsurance, co-pay, OOP, and deductibles will be calculated with accuracy and applied based on the benefit plan.
  • Have a customized reporting system for Quality reports, Inventory, Production, Pend & Skip reporting.

Are you looking for Outsourcing Medical Claims Adjudication Services & Solutions?

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