Built for Scale. Tuned for Accuracy. Designed for Oversight.
Imagenet helps healthcare payers overcome volume spikes, compliance pressure, and costly rework with a high-performance adjudication model designed around your needs:
Real-Time Oversight
Proven to handle 12.5x daily claim volume surges with consistent speed and accuracy.
Flexible Delivery Models
Seamless system integration with strong visibility into performance and audit readiness.
Proven Accuracy
>98% processing accuracy across institutional, professional, and complex claim types.
Specialized Expertise Delivers Superior Results
Claims adjudication demands precision, speed, and up-to-date regulatory alignment. Using efficient workflows and deep domain expertise, we process both simple and complex claims with accuracy and compliance. Our modular solutions integrate with your existing systems to help you scale quickly and improve efficiency and turnaround.
Core Capabilities
- Comprehensive front-end processing
- High-volume adjudication
- Payment integrity
>98%
Processing Accuracy
25+
Years of Experience
SOC 2 Type II
Certified
Improving Appeals Workflows, Compliance, and Accuracy
Our team handles appeals of various complexities. We meticulously examine all appeals documentation for accuracy and completeness. Plus, our code edit reviews ensure that claims align with the current regulations and guidelines.
Key Services Include:
- Identifying underpayments or clinical appropriateness concerns
- Addressing provider requests for reconsideration
- Evaluating cases that may warrant waivers of liability
- Providing comprehensive support for Medicaid state hearings
- Ensuring CMS IRE submissions meet all necessary requirements
Case Study: Imagenet Supports a 12.5x Increase in Daily Claims Processing
Claims adjudication demands precision, speed, and up-to-date regulatory alignment. Using efficient workflows and deep domain expertise, we process both simple and complex claims with accuracy and compliance. Our modular solutions integrate with your existing systems to help you scale quickly and improve efficiency and turnaround.
Core Capabilities
- Comprehensive front-end processing
- High-volume adjudication
- Payment integrity
“Imagenet scaled quickly, integrated seamlessly, and delivered exactly what we needed to stay compliant.”
— Director of Claims Operations, Large Public Health Plan
Frequently Asked Questions
What makes Imagenet’s claims adjudication model different from traditional outsourcing?
Imagenet integrates directly into a payer’s existing systems, providing high‑volume adjudication capacity, real‑time oversight, and >98% processing accuracy, without requiring platform replacement or operational disruption.
How does Imagenet help payers manage volume spikes and turnaround time requirements?
With proven ability to scale up to 12.5x daily claim volume, Imagenet deploys trained adjudicators, efficient workflows, and integrated data processes to keep turnaround times on track, even during surges.
What types of claims does Imagenet support?
Imagenet processes institutional, professional, and complex claim types, including front‑end processing, high‑volume adjudication, payment integrity reviews, and appeals requiring regulatory alignment.
How does Imagenet ensure accuracy and compliance in claims adjudication?
The model combines payer‑trained adjudicators, strong QA processes, SOC 2 Type II controls, and real‑time visibility into performance. Code edit reviews and regulatory alignment ensure claims meet current guidelines.
Does Imagenet support appeals and regulatory submissions?
Yes. Imagenet handles appeals of varying complexity, including reconsiderations, underpayment reviews, waivers of liability, Medicaid state hearings, and CMS IRE submissions—ensuring documentation accuracy and compliance.