Claims Adjudication Services

Improve Provider Satisfaction and Payment Compliance

with Imagenet's Transformative Adjudication Services

STREAMLINING CLAIMS PROCESSING: IMPROVE CLAIMS ACCURACY AND EFFICIENCY WITH IMAGENET'S ADJUDICATION EXPERTISE

At Imagenet, we understand the critical role that claims adjudication plays in the healthcare payer industry. Our Claims Adjudication services are meticulously designed to optimize your operations, ensuring accuracy, efficiency, and compliance. Discover how partnering with Imagenet can transform your claims processing and elevate your organization's performance.

With decades of experience, Imagenet understands the intricate knowledge it takes to properly manage an adjudication team. That’s why we’ve developed customizable and scalable solutions that meet the demands placed on modern health plans. Imagenet’s leaders are armed with the knowledge and tools to navigate the complex realm of Claims Adjudication.

Featured Services

Medicare

Medicaid

Commercial

Exchange

Professional Claims

Institutional Claims

Dental

Atypical Providers

Correspondence

Appeals

Provider Disputes

Coordination of Benefits

High Dollar Claims

Prior Authorization

Benefit Limits / Accumulators

In Network

Out of network

Unlisted codes

Advanced Workflow Solutions

Detailed reporting

KPI Dashboards

ELEVATE YOUR CLAIMS WORKFLOW WITH IMAGENET'S COMPREHENSIVE ADJUDICATION SOLUTIONS

Imagenet has developed a range of services to help our clients meet the expectations of their provider networks, members, and compliance auditors. Our claims experts craft custom solutions seamlessly integrating into your existing workflows, enabling your claims department to optimize resources to meet growing business demands.

STREAMLINING CLAIMS PROCESSING: IMAGENET'S PRECISION-DRIVEN ADJUDICATION SERVICES

Claims adjudication is the backbone of any healthcare payer organization. It's a process that demands precision, timeliness, and adherence to complex regulatory requirements. Handling claims efficiently while minimizing errors is essential not only for operational efficiency but also for member satisfaction and cost control.

However, the challenges are significant. The intricacies of healthcare billing, constant regulatory changes, and the need for compliance make claims adjudication a complex task. Manual processes can be error-prone, leading to delayed payments, claim denials, and member frustration. Moreover, the volume of claims can be overwhelming, placing a tremendous burden on your resources.

Regardless of your system configuration, our staff is well-versed in all pricing methodologies, including proprietary and non-standard pricing agreements. Imagenet provides comprehensive support, freeing up IT resources for other critical tasks.

  1. Precision: Imagenet's skilled team ensures that each claim is meticulously reviewed, verified, and processed with precision. We leave no room for errors, reducing costly rework and denials.

  2. Efficiency Optimization: We understand that time is of the essence in claims processing. Imagenet streamlines your workflow, accelerates claims adjudication, and enhances turnaround times.

  3. Compliance Expertise: Staying up-to-date with ever-changing healthcare regulations can be a daunting task. Imagenet's team is well-versed in compliance requirements, ensuring that your claims meet all necessary standards.

  4. Seamless Integration: Imagenet's Claims Adjudication services seamlessly integrate with your existing systems. Transitioning to our services is smooth and hassle-free.

Key advantages:

  • Error Reduction: Minimize errors, rework, and claim denials with our precision-driven approach.

  • Enhanced Efficiency: Improve your claims processing speed and reduce turnaround times.

  • Cost Control: Streamline your operations and allocate resources more efficiently.

  • Compliance Assurance: Stay in compliance with ever-evolving healthcare regulations.

  • Member Satisfaction: Deliver prompt and accurate claims processing, enhancing member experiences.

APPEALS

Navigating the intricate landscape of Medicaid and Medicare appeals is a task that demands a thorough understanding of regulations and a commitment to precision. Imagenet stands as your trusted partner in this critical phase of claims adjudication, ensuring that your organization meets the highest standards of compliance and accuracy.

OUR EXPERTISE

Imagenet's Appeals experts are well-versed in Medicaid and Medicare appeals processing guidelines, adhering to the rigorous standards set forth by Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals. Our team is not only knowledgeable but also deeply experienced in handling appeals of various complexities.

Imagenet's Appeals services and solutions include comprehensive reviews that leave no stone unturned. We meticulously examine appeals documentation, scanning for accuracy and completeness. Our code edit reviews ensure that claims align with the most current regulations and guidelines.

Empowering Your Organization: Our Appeals workflows are designed to empower your organization in the following areas:

  • Underpayment or Referral for Clinical Appropriateness: Imagenet's experts can identify cases where claims may have been underpaid and require a closer review. Additionally, we assess claims for clinical appropriateness, ensuring that services rendered align with the highest standards of care.

  • Provider Requests for Reconsideration: We facilitate the process of reconsideration, ensuring that provider concerns are addressed promptly and fairly. Our goal is to foster positive relationships between your organization and your network of healthcare providers.

  • Waiver of Liability: Imagenet assists in evaluating cases that may warrant a waiver of liability. This process is handled with meticulous care to ensure compliance with relevant regulations.

  • CMS IRE Submission Regulations: Our team is well-versed in the submission regulations outlined by the Centers for Medicare & Medicaid Services (CMS) Independent Review Entity (IRE) process. We ensure that submissions meet all necessary requirements.

  • Medicaid State Hearings: Imagenet provides comprehensive support for Medicaid state hearings, from documentation preparation to representation during the hearing process.

  • Streamlined Implementation Process: The success of our Appeals services is underpinned by our collaborative approach to implementation. We work closely with you and your staff to gain a full understanding of your organization's unique needs. Once the assessment is complete, our resources are deployed strategically to either augment your workforce or serve as a comprehensive Business Process Outsourcing (BPO) provider.

Imagenet's commitment to precision, compliance, and efficiency extends to every aspect of Appeals processing. We recognize the importance of this phase in ensuring equitable outcomes for all parties involved, from your organization to the members and providers in your network.

THE SUPPORT YOU NEED, WHEN YOU NEED IT

Our streamlined implementation process is achieved through close collaboration. We work closely with you and your staff to gain a comprehensive understanding of your organization's needs. Our resources are then deployed to either augment your workforce or serve as a comprehensive BPO provider.

EXPERIENCE THE DIFFERENCE

At Imagenet, we are committed to delivering results you can see, hear, and feel. Our Claims Adjudication services are designed to enhance provider satisfaction, ensure payment compliance, and streamline the complexities of claims processing. Discover the Imagenet difference today.