Claims Adjudication Services
Improve Provider satisfaction and payment compliance
with Imagenet’s transformative Adjudication Services
CLAIMS ADJUDICATION
Imagenet’s Claims team is comprised of industry leading experts, equipped with the knowledge and tools to help your team navigate the complex work of Claims Adjudication.
Imagenet has developed a host of services to help our Clients meet the expectations of their provider networks, members, and compliance auditors. Imagenet’s Claims experts build custom solutions that facilitate seamless integration into our Client’s existing workflows. Our comprehensive Claims solutions will enable your Claims Department to focus its resources on improving their workflow to meet your growing business needs.
Regardless of your system configuration, we can help. Our staff is familiar with all pricing methodologies and can help administer to proprietary, non-standard pricing agreements. Imagenet delivers comprehensive support, allowing you to focus IT support and development resources elsewhere.
APPEALS
Imagenet is familiar with Medicaid and Medicare appeals processing guidelines. Our services & solutions provide detailed Appeals review, documentation scanning, and code edit reviews in accordance with Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals. Our Appeals workflows enable:
Underpayment or refer for Clinical Appropriateness
Provider Requests for Reconsideration
Waiver of liability
CMS IRE Submission Regulations
Medicaid state hearings
Our streamlined implementation process is made possible by our collaborative approach to implementation that requires our team to work closely with you and your staff to gain a full understanding of your organization’s needs. Our resources will then be deployed to help augment your workforce or as a comprehensive BPO provider.
