Highly scalable, highly effective healthcare claims adjudication services
Experience maximum benefits sooner—with fast implementations
and deep experience processing complex claims
Specialized expertise delivers superior results
Claims adjudication requires extreme precision, timeliness, and adherence to rapidly evolving regulatory requirements. With a highly experienced team made up of expert claims examiners, we can handle any of your claims needs—from the most straightforward to the most complex.
Plus, with custom solutions that seamlessly integrate into your workflows, we can scale up quickly so that you can experience the benefits—including enhanced accuracy, efficiency, and compliance—sooner.
Core capabilities
Claims processing
Auditing
Appeals
Streamlining and enhancing your processes
We have unique industry experience processing complex claims backed by our commitment to recruiting, hiring, and training expert claims examiners.
More accurate
We review, verify, and process each claim with precision, leaving no room for error and reducing costly rework and denials.
More efficient
We streamline workflows, accelerate claims adjudication, and reduce turnaround times.
More compliant
We’re always on top of the latest compliance requirements, ensuring your claims meet all necessary standards.
99.8%
financial accuracy
96%
procedural accuracy
SOC II Type 2
certified
Improving appeals workflows, compliance, and accuracy
Our team handles appeals of various complexities. We meticulously examine all appeals documentation for accuracy and completeness. Plus, our code edit reviews ensure that claims align with the current regulations and guidelines.
Key services include:
Identifying underpayments or clinical appropriateness concerns
Addressing provider requests for reconsideration
Evaluating cases that may warrant waivers of liability
Providing comprehensive support for Medicaid state hearings
Ensuring CMS IRE submissions meet all necessary requirements
Empowering you in multiple ways
Reduced errors
Enhanced compliance
Improved member and provider satisfaction
Case study: Imagenet supports a 12.5X increase in daily claims processing
A large public health plan was overwhelmed by a massive backlog of Medicare claims and at risk of state sanctions. They partnered with Imagenet, and we implemented our claims adjudication model, while simultaneously recruiting and training 40 highly qualified staff to process the backlog. The result: A 12.5X increase in daily claims processing.
Ready to accelerate your processes with our healthcare digital mailroom services?