Deep understanding of the various insurance claim processing
business by the vast number of BPO's in India has resulted in matured
process flows, highly dependable claims adjudication system and fully
scalable total solutions in processing and adjudicating high volume
- The claims adjudication process involves checking whether the
individual is covered by an active insurance policy and then checking
the information against the insurance companies master database.
- Identifying duplicate claims is another function undertaken by the
BPO's .The next step involves tracking the members eligibility, history,
provider assignments, and coordination of benefits and finally
adjudicating whether or not the claim is a valid claim.
- Next step involves collection of all the data required for processing
the claims and then the BPO determines adjudication based on user
defined criteria. All the data collected goes through adjudicating
engine for thousands of validation edits for data quality, data
consistency, format validity, HIPAA compliance etc.
- Lastly, the final output of adjudicated claims is then sent over to
the insurance provider to pay or reject the claim. Then a detailed
report on all the claims is compiled by the BPO which are adjudicated as
per the requirements of its clients on a daily basis.
The various insurance services provided by the BPO's in India result in
increased administrative efficiency, reduced costs, quick settlement of
claim payments and a true return on investment.