Scalable, Intelligent Claims Adjudication Built for Complexity
Delivering speed, precision, and compliance without compromising on complexity.
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
Streamlining and Enhancing Your Processes
We have unique industry experience processing complex claims backed by our commitment to recruiting, hiring, and training expert claims examiners.
More Accurate
Powered by intake-aware workflows and thorough verification, reducing denials and rework even for complex, unstructured inputs.
More Efficient
Automation + expert oversight accelerate adjudication and lower manual effort.
More Compliant
Built-in controls and continuous updates keep your adjudication aligned with evolving regulations.
>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
Empowering You in Multiple Ways:
Reduced Errors
Enhanced Compliance
Improved Member and Provider Satisfaction
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.
See What Imagenet’s Claims Solution Can Do for You