Claims Management

  • Claims Intake
  • Claims Pre – Adjudication
    • Claims Data Entry
    • Claims Validation
    • Provider Eligibility Validation
    • Member Eligibility Verification
    • Edit Resolution
  • Adjudication
    • Coding Verification
    • Edit Resolution
    • Claims Re-pricing
    • EOB Processing
    • Provider and Member Appeals handling
    • Claims Audit
    • Aged Claims Reporting
  • Post Adjudication
    • EOB Printing
    • Customer Service – Member and provider
    • Appeals and Grievance communication
  • Collection
    • Over payment and under payment processing
    • Provider and Member Follow-up and Recovery
    • Analysis Report
  • Audits
    • Reimbursement audits
    • Coding audits
    • DRG coding audits