What Happens After Adjudication? | Insurance Claims Processing

[@christiantaguinod7482]

I'm learning a lot in your videos. I'm currently working as an AR agent. Hope you also discuss about different denials and you overturn that denials. Plsss thanks

[@InleraU]

Thanks so much for the feedback! I will definitely add that to our list of ideas, keep an eye out for it in a future video!

[@cherylyeatman2929]

As a new practice there was a period of time where we had patients seen while our applications were pending. What would be the correct process to be able to adjust these balances, now that we have an effective date? Unfortunately, there was a miscommunication and our effective date wasn't as early as understood due to contract negotiations. Some claims have been filed as out of network claims. What is the best and most correct action to not become an unnecessary burden to the patients without writing off the whole claim? Can an administrative adjust be made down to in network rates, is with NSA? Caviat is that this is an outpatient practice, not a facility. Should the claims be withdrawn and a cash rate be charged with a prompt payment adjustment to take it down to in network rates?

[@InleraU]

Thank you so much for your question! You will need to send a request to have the insurances re-process the claims unfortunately, that entered this typically needs to be done in writing or via payer portal and with a detailed list of the claims that need to be re-processed. Keep in mind you will need to take into consideration your effective date. The insurance will only re-process the claim as a network for those visits after the effective date. If it’s for a number of Claims, I would recommend including a spreadsheet that has the patients name, date of birth, ID number, date of service, billed amount and the insurance internal claim number (ICN)

[@amandaloughry4550]

Ty so much for your very informative explanations! I can understand a lot of these terms more easily because of you😊

[@InleraU]

Thank you for the kind words! We're glad you're getting value from our content. Let us know if there's anything else you'd like for us to cover!

[@amandaloughry4550]

@@InleraU ty because you've helped so much

[@WhippedFood]

Very interesting video :D Thanks for sharing !

[@InleraU]

Thanks! So happy you found it helpful :)) What other healthcare topics are you interested in learning about?

[@mohitnagpal5589]

Please make a video on disability insurance adjudication

[@InleraU]

Can you clarify what exactly you need to know abotu the adjudication of a claim from a disability carrier. Usually, those claime are reimbursed a 100% without any patient liability and will often required prior authorizations and medical notes be submitted with each claim.

[@magicjohnson6892]

I've been adjudication process for over 8 weeks. Now they tell me about some escalation process. Its always something. Can you explain why

[@InleraU]

Unfortunately, some insurance carriers greatly delay the claims process. They are required by law to give you an update within 30days because of the Prompt Payment Laws so you can threaten with filing a complaint if they are not processing in a reasonable timeframe. Here is the website with more info on the Prompt Pay Requirement www.ncdoi.gov/insurance-industry/form-and-rate-filings/life-and-health/prompt-pay-requirement#:~:text=State%20Law%20%2D%20Law%20requires%20claims,insurer%20must%20deny%20the%20claim.

[@satyamkamal5678]

How much a normal people get paid in US or anywhere in claim Adjudication with a year of experience?

[@InleraU]

I know very little about the claim djudication position as that takes place on the insurance carrier end.

[@Sil3ntsongbird]

I'm going through the workman's comp process. I got a lawyer and all of the sudden I got an adjudication and didn't receive my check that I was expecting. I'm a nervous wreck not knowing what is going on. I still have Drs appointments and am going through the process still so I'm anxious and confused 🥺

[@InleraU]

Thank you for your comment! I understand how confusing and stressful the workmans comp process can be. I hope your adjudication process had a positive outcome.

[@yolonda7486]

I appreciate your detailed explanations regardless of the subject :)

[@InleraU]

Yay!! :-) Glad to hear that! So happy your find them helpful. Feel free to let me know of any topics you would like for me to cover in future videos.

[@trudybettinger2773]

I want to get more from You

[@InleraU]

We're happy to hear that! Is there anything specific you want to learn about?

[@WilliamCurry-bh3dk]

****QUESTION Veteran Adjudication*****

[@InleraU]

Thank you for your comment! The veteran adjudication process is separate from the general context of our channel. However, it’s a process when the VA reviews and investigates your claim and against their regulations prior to approval.