Pre-Adjudication Support

Payers and TPAs setup their claims engines to auto-adjudicate claims received from providers. During auto-adjudication, the claims engine verifies member/patient eligibility and provider information on a claim using the client’s database. Any claims that do not match are exported to the manual adjudication queue. However, manual adjudication results in a fluctuation of quality, as manual adjudication can never be as efficient or accurate as the auto-adjudication process. Vee Healthtek provides a solution to this problem by matching member and provider information on claims against the client’s database before the claim is even loaded into the system.

• Providing matches using the appropriate business rules
• Loading the unique pointer into the claim file so it can be loaded into the engine
• Manually matching any claims that cannot be automatically matched
• Creating database records
• Adding providers’ specialty and category from the NPIDB to new provider records
• Capturing the client’s database’s unique IDs and adding them to the claims’ EDI files
• Instant identification of appropriate eligibility so that provider records can move on to the next step of the auto-adjudication process

All these features of our pre-adjudication support result in better quality, a faster turnaround time, and a reduction in manual labor, saving you time and money, time, and a reduction in manual labor, saving you time and money.