
Claims Adjudication Service
“Claims adjudication” is a phrase used in the insurance industry to refer to the process of paying Medical claims submitted or denying them after comparing Medical claims to the benefit or coverage requirements.
Monarch RCM provides high-quality claims adjudication services to insurance providers as well as third party administrators. Our have strong claim adjudicators are trained on multiple adjudication platforms and have comprehensive knowledge of US healthcare reimbursement Rules. We leverage this expertise and back it with a well-defined process and latest technology to ensure issues like unwanted claims, delayed claim execution, and duplicate claims do not impact the revenues of our clients.
Our
Adjudicating Check
Analyzing validity of claims with fraud detection
Cleaning Duplicate Claims
Establishing Medical Service Provider Type
Validating Data Against Adjudicating Engine
Commitment Fully Adjudicated Claims

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How
Works
Step - 1
Eligibility Verification
Step - 2
Verification of Duplicate/Fraud Claims
Step - 3
Coding
Step - 4
Detailed Analysis for Provider
Step - 6
Benefits Determination Adjudication
Step - 6
Rules Besed Edits (CCI-Edits)
Step - 7
Recommendation
Types of
Adjudicating Check
CMS 1500
Dental Claims
UB92 Or UB04
Vision Forms
Correspondence
Call us To Analyze your Practice.