For uninterrupted cash flow, the claim adjudication process must be error-free and handled by experts. Dental claim adjudication services require accurate evaluations to understand how the insurer determines the claim reimbursement paid, denied, or rejected. There are systematic protocols involved in the process to submit and follow-up dental claims adjudication services. Here are the steps of the dental claim adjudication process:
The Initial Processing Claim Review
It is the first and foremost step, where experts check the claims to detect any omissions or simple claim errors. The insurer identifies the problem and denies the request for any of the below mentioned reasons. Then, after the corrections, resubmit the claim for payment within the time frame.
The Automatic Claim Review
The second step of the adjudication services detects any incorrect information about the insurance payer’s payment policies. Any invalid submissions then are resubmitted and rectified to save a lot of time. Here are few problems identified in this step:
The Manual Claim Review
The third step includes the authentication of all documents by the claim examiners to crosscheck any invalid, missing, or mismatched data. This mandatory claim process is basically for unlisted procedures to identify medical necessity. Records are requested and checked through the latest tools and also manually review wherever necessary.
Payment Determination Process
The three types of payment determination of the claim adjudication process are as follows:
The Final Payment
The final stage of the dental claim adjudication process includes the final pay-out details. The payment is set forth to the notified office. It is called the remittance advice or explanation of payment. That contains the breakdown of the reimbursement, adjustment, denial, and uncovered charges of a claim. The elucidation of benefits includes the following information like allowed amount, approved amount, covered amount, discount amount, payer paid amount, patient responsibility amount, and adjudication date.
Why Outsource Dental Claim Adjudication Services?
Outsourcing to experts can help process more claims in a month with the latest billing technology. Here are few benefits of choosing a team of dental claim adjudication services.