Efficient Claims Adjudication with MediPay

MediPay optimizes the claim adjudication process by automating the evaluation and resolution of claims, reducing manual intervention and speeding up processing times. Each claim undergoes thorough claims validation, where it is checked for accuracy, eligibility, and policy compliance to ensure adherence to coverage rules before adjudication. This helps minimize errors and denials, ensuring smooth processing.

The automated adjudication engine applies preset rules and benefit structures, determining payment amounts, deductibles, and co-pays quickly and accurately. Claims that require further attention are flagged for manual review, while the system handles the majority of claims autonomously.

For denied claims, MediPay offers comprehensive denial management tools, providing auto-notifications and efficient resubmission workflows to resolve issues swiftly. Detailed claims adjudication reports offer real-time visibility into processing metrics, denial rates, and payment timelines, helping providers and payers track performance and improve decision-making.

The system also supports medical coding standards like ICD-10, CPT, and HCPCS, ensuring that claims are processed in compliance with industry regulations, further enhancing the accuracy and reliability of the adjudication process.