Adjudication is the process of verifying that entered claims follow all the billing rules. You can adjudicate a batch of claims or work on a claim individually and manually adjudicate. When a claim successfully completes the adjudication process, the claim is marked as ready to be paid. The Adjudication Rules can be set up for each insurer or the same for all insurers in Administration to be applied on claim lines.
If the claim fails any of the adjudication rules, the claim is marked as denied or pended. A user can then correct the claim line for missing or erroneous information and mark the claim as re-adjudicate.
When going through the adjudication process again, if all rules are passed, the claim is marked as approved.
You can:
Adjudicate an Individual Claim
Display the Claim Lines (###) list page. Tell me how...
The Claim Lines (###) list page is displayed. View field definitions.
Set filters to display claim lines to adjudicate:
· Filter for the insurer to adjudicate claims for
· Select the status either "To be adjudicated" or "Entry Complete"
Click the Apply Filter button.
The claim lines that match the filters are displayed in the List area of the page. The Adjudicate icon in the task bar is activated.
Select the claim lines you want adjudicate. Select individual claim lines or click the All or All on Page icons in the middle of the page above the list area.
Click the Adjudicate
icon in the task
bar.
The Adjudicate Claims window is displayed with the selected claim lines listed. View field definitions.
When you are ready to adjudicate the claims, click the Adjudicate 
button.
When the batch has been processed, the Batch ID is displayed. Refer to the red arrow in the screen image below.
Make note of the Batch ID.
If desired, click the Save as button to create an Excel spreadsheet of all the claim lines in the batch.
Click the Close 
button to close the window.
Display the Claim Line Detail page for the client whose claim you want to adjudicate. Tell me how...
s
Click the Adjudicate
icon in the task
bar.
The Adjudicate Claims window is displayed. View field definitions.
When you are ready to adjudicate the claim, click the Adjudicate
button.
If the claim passes all the adjudication rules, a message is displayed in the window indicating the process was successful.
If desired, click the Save as button to save the claim lines to an Excel spreadsheet.
Click the Close button to close the window.
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