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Healthcare claims

Healthcare claims Adjudication

SRM has the best team of medical claim examiners who know rulebook of the adjudication framework. With decades of experience in electronic and manual adjudication, we will adjudicate claims at record speeds. Our team will look for duplicates, errors, and other discrepancies that result in delay or denial of claims.

Synergy Resources is a leading healthcare BPO that has professionally handled medical claims processing outsourcing tasks. our team of medical claim examiners stays updated on the latest practices. 

Healthcare claims Adjudication

Our healthcare claims adjudication services include -

  1. Determination of Claims Value
  2. Explanation of Benefits
  3. Investigation of Claims for Duplicates
  4. Adjudication of Insurance Benefits
  5. Data Extraction from Raw Claims
  6. Checking Data Accuracy with Claims Adjudicating Engine
  7. Review of Diagnostic Code and Patient Data
  8. Evaluation of Healthcare Service Provider Details
  9. In-depth Claims Validation for fraud detection
  10. Execution of Adjudicated Claims
  11. Claims Adjudicating Entitlement
  12. Computing Claims Amount
  13. Coding, Bundling, And Review
  14. Benefit-Based Determination Adjudication

Our healthcare claims adjudication services include -

Healthcare claims adjudication is a strenuous process that requires comprehensive knowledge of the cost containment measures to fight fraud. This task becomes complicated if you do not have a skilled team to adjudicate claims with agility and precision. Outsourcing healthcare claims adjudication to Synergy solves most of your concerns as we have people who are adept at manual and electronic claims adjudication.

Our healthcare claims adjudication process is as follows -

1. Receive Claims Data from You

2. Check for Eligibility

3. Check to Avoid Duplicate Claims

4. Benefit Determination Application

5. Analysis of Hospital Details

6. Coding, Bundling & Diagnosis Review

7. Rules-Based Edits

8. Claims Settlement

9. Claims Presentment

Other Services We Offer

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