ShanBioSys providing global clients with high-quality healthcare claims adjudication services for almost two decades now. Being in the industry for so long, we have the required knowledge and experience to efficiently carry out claims adjudication and can cater to any type of client requests.
Our team of adjudicators can help you manage claims in the most efficient manner. Some of the major types of claims we can help you process include-
Claims Adjudication Process We Follow
With extensive experience in the healthcare insurance industry, we understand each and every type of complication that may arise in this process. Our team is experienced in handling such complications and understanding process intricacies to provide efficient services within a quick turnaround time. This is possible by following a systematic and streamlined claims adjudication process. The steps involved in our process are listed here -
Initial Processing Review
In the first step, the claims are thoroughly checked for errors and omissions. The claim can be corrected and resubmitted for payment when the claim is rejected for any of the following reasons -
Incorrect or wrong patient name
Wrong plan or subscriber identification number
Incorrect place of service code
Wrong date of service
Invalid or missing diagnosis code
Mismatch of service and patient's gender
Automatic Review
In this step, claims are checked in detail for items which apply to the payment policies. The issues identified during the automatic review include -
Eligibility of the patient on the date of service
Absence of authorization and pre-certification
Invalid authorization and pre-certification
Duplicate claims are submitted
Filing deadline has been crossed
Invalid procedure or diagnosis code
The services are not necessary medically
Manual Review
In this step, medical claim examiners check the claims manually. It is common for nurses and doctors to perform manual checks and compare the medical documentation with the claims. This step is performed for any type of medical procedure and is especially done for a procedure which is not listed.
Payment Determination
There are basically three types of payment determinations. They are -
Paid - If the claim is considered paid, the payer determines if the claim is reimbursable
Denied - If the claim is considered denied, the payer determines that the claim is non-reimbursable
Reduced - When the billed amount is too high for the diagnosis, the claims examiner can down-code to a lower level as deemed appropriate
Payment
The payment submitted by the insurance payer to the medical care provider is referred to an explanation of payment. It includes the following data -
Allowed Amount
Covered Amount
Patient Responsibility Amount
Approved Amount
Payer Paid Amount
Discount Amount
Adjudication Date
Why Choose Us for Claims Adjudication?
Being a leading provider of healthcare BPO services to clients worldwide, we have the required skills and expertise to handle any type of client requests. Outsourcing claims adjudication services to us can help you take advantage of the following benefits -
All our clients will be billed based on the number of claims processed per day, work volume, etc. This assures quick and efficient services at affordable rates
HIPAA Compliance
We sign a HIPAA agreement with every client before we begin the project hence you can be assured that the patient data is divulged to any third-party and be completely secure
Best Infrastructure
We have the state-of-the-art infrastructure in terms of world-class office spaces, uninterrupted network, etc. which enables us to quickly provide all our clients with world-class services
Leverage Advanced Software
We make use of some of the latest and updated versions of the best claims adjudication tools and technologies
Quick Turnaround Time
We have multiple delivery centers around the globe across different time zones, which allow us to deliver the results within a quick turnaround time
Qualified Team of Adjudicators
Our team comprises of highly skilled, talented, qualified, and experienced adjudicators and insurance experts who are capable of catering to any type of client needs
Easily Scalable Services
We have the required bandwidth to easily scale up or down the claims adjudication process as per the client's requirement
24/7 Availability
We assign a dedicated project manager when you outsource to us who will be a single point of contact for all your queries and project updates 24/7 via phone or email
Outsource Claims Adjudication Services to Us
ShanbioSys is a leading adjudication services in India and a range of other healthcare services to global clients for over 18 years. All our clients have benefited from our high-quality services and operational efficiency. The team at ShanBioSys is flexible in adjudicating claims payment by either using the customer's payment system or our own in-house claims system.
Whatever claims adjudication requirements you have, we are capable of taking care of your claims adjudication process needs in a professional manner. Get in touch with us today to discuss your project needs.
Find out more about how we can help your organization navigate its next. Let us know your areas of interest so that we can services you better.