Whether it is manual or electronically submitted claims we will scrutinize the claims record to ensure accuracy in patient names, diagnostic codes, and process claims that are valid and reimbursable. Our medical claim examiner will closely examine claims after the application of insurance and reject ones that are partially fulfilling, duplicate, or erroneous. Our diligent claims adjudication practices will speed up claims execution and help you contain risks that impact your profit.


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    Healthcare Claims Adjudication Services We Offer

    Mbsap has experienced teams of medical claim examiners who have decades of experience in manual and electronic claims adjudication. We are proud partners to over 500 hospitals and insurers worldwide. We constantly update our knowledge base via workshop sessions to stay equipped against the latest challenges that delay the payment process. Our claims adjudication services include –

    •  Medical Claims Processing
    •  Medical Claims and Encounter Processing
    •  Remittance Processing
    •  Medicare Reimbursement Services
    •  Dental Claims Adjudication Services
    •  Determination of benefits
    •  Verification of provider details
    •  Detection of fraudulent claims
    •  Ensuring correctness of raw claims data
    •  Performing rule-based edit
    •  Eligibility Checking
    •  Verification for duplicate claims
    •  Recommendation of changes to rejected claims

    Type of Medical Claims We Adjudicate

    Some of the major types of claims we process include, but not limited to –

    • HCFA 1500 / CMS 1500
    • UB92/UB04
    • Dental Claims
    • Pends / Correspondence
    • Enrollment Forms Processing (EFP)
    • Vision Forms
    • Miscellaneous (Complex / Non-standard)

    Apart from processing the above-mentioned types of claims, we also have the required skills, expertise, and bandwidth to provide our clients with the following related services –

    • PPO Repricing
    • Forms Processing
    • Insurance Fraud Detection
    • EDI Integration

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