CLAIMS ADJUDICATION
Get Claims to Accurate, Compliant Decisions Faster
Combine AI-assisted workflows, integrated data, and payer-trained adjudicators to handle both routine and complex claims at scale, reduce rework, and keep turnaround times on track.
Built for Scale. Tuned for Accuracy. Powered by Insight.
Imagenet helps health plans overcome volume spikes, compliance pressure, and costly rework with a high-performance adjudication model designed around your needs:
High-Volume Capacity
Proven to handle 12.5x daily claim volume surges with consistent speed and accuracy.
Real-Time Oversight
Seamless system integration with 24/7 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 technology-enhanced 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 realize improvements in efficiency and turnaround.
Core Capabilities
Claims processing
Auditing
Appeals
>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
A large public health plan was overwhelmed by a massive backlog of Medicare claims and at risk of state sanctions. They partnered with Imagenet, and we implemented our claims adjudication model, while simultaneously recruiting and training 40 highly qualified staff to process the backlog. The result: A 12.5X increase in daily claims processing.
“Imagenet scaled quickly, integrated seamlessly, and delivered exactly what we needed to stay compliant.”
— Director of Claims Operations, Large Public Health Plan
See What Imagenet’s Claims Solution Can Do for You