Navigating the Complexities of Claim Adjudication: Strategies for Efficient Service Reason Evaluation

Authors: Praveen Kumar Vutukuri

DOI: https://doi.org/10.5281/zenodo.14059516

Short DOI: https://doi.org/g8qjrk

Country: USA

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Abstract: Claim adjudication is a critical process in healthcare that determines the validity of submitted claims based on various service reasons. This paper explores the extraction of service reason logic within the claim adjudication framework, emphasizing its impact on operational efficiency, cost reduction, and compliance with regulations. By analyzing current methodologies and employing automated systems, we propose a structured approach to enhance the accuracy and speed of claim processing.

Keywords: Claim Adjudication, service reason logic, Healthcare Organization, Reimbursement, Algorithms, Healthcare Automation, Coding, Compliance.

Paper Id: 231480

Published On: 2024-06-04

Published In: Volume 12, Issue 3, May-June 2024

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