Medical Claims Adjudication
Mitigate fraud. Contain costs. Increase productivity.
Data Dimensions is a leader in providing claims adjudication processing. Our expert staff helps our clients fight fraud, contain costs, increase productivity, and focus on their core competencies.
Our adjudicators receive comprehensive training in procedures, techniques and judicial requirements. Our adjudicators also are trained on your specific adjudication platform and receive ongoing training to ensure they remain knowledgeable on ever-changing adjudication information.
Data Dimensions understands each client has unique requirements. Our Project Managers work with you to create a detailed project plan, verify requirements, and determine the critical success factors to satisfy your business needs.
- Adjudicating entitlement
- Identifying duplicate claims
- Analyzing validity of claim/fraud detection
- Extricating “data components” from raw claims
- Calculating valid claim amount
- Establishing medical service provider type
- Validating data against adjudicating engine
- Committing fully adjudicated claims