What is Adjudication? | The 5 Steps in process of claims adjudication

[@VicasBobbyMehta]

5 steps in Adjudication - the info insurance companies are looking for in claims in medical billing 1) 1:15 Claim is NOT Duplicate 2) 1:37 All necessary details are present 3) 2:44 Participation, Expectations, Rules 4) 3:43 Determine if benefits ALLOW for the service 5) 4:20 Final Determination (Payment or Denial)

[@InleraU]

Thank you!

[@jn9631]

Thank you so much for posting this! Super helpful and easy to digest. And I agree, you are a great presenter. Look forward to learning more!

[@InleraU]

Yay :-)) Thanks so much! I truly apprecite your feedback and so happy you have found it helpful!

[@lynnf3337]

This was one EXCELLENT video. You're quite the presenter! I learned so much in the 6-ish minutes it took to watch. Thank you!!!

[@InleraU]

Wow, thanks! I so appreciate the phenomenal feedback!

[@prithimeenan]

Thank you so much!! Really Helpful. Please do more technical videos like this one . ❤ Wishing you the best !

[@enaklptrck3839]

Thank you for creating these videos. I have been a biller for many years and it serves me to better communicate with management. On interviews the billing terminology is a must. Also, you are a great presenter. Look forward to learning more! 4 Reply

[@InleraU]

You're welcome! Thank you for watching and enjoying them! Let us know if you have any specific topics you'd like us to cover 😄

[@jn9631]

Thanks!

[@InleraU]

You are so very welcome! Thanks for the love :))

[@muhammadakmal9302]

you teaching way is so amazing 👍🏻

[@InleraU]

Oh so kind of you. Thank you 🙏🏽

[@videoXYZ85]

Good one

[@InleraU]

Thank you!

[@Sunmeet4424]

Please upload some videos about Denials & their explanations.

[@InleraU]

Thanks Sunmeet! I will absolutely work on recording a few of the top denials and get them up as soon as possible

[@jung71ryu]

Thank you for taking your time explaining this process.

[@InleraU]

You are so very welcome :-) Glad it was helpful! Feel free to let me know of any additional topics you would like covered in a future video.

[@dbilbrew1431]

Great vide again on these 5 steps of adjudication. Would you also post a video concerning EOB's? Especially as they relate to the UB and 1500

[@InleraU]

Thank you for watching. I will add this topic "video concerning EOB's related to the UB and 1500" to our video's list.

[@rahulzagade89]

Thank you fr this knowledge

[@InleraU]

You are so very welcome! Thank you for your comment!

[@sharmilatapkir4787]

Wow Great Job 👍👏

[@InleraU]

Thank you! Cheers!

[@PharmacyTechLove]

Thank you.

[@InleraU]

You are so very welcome! Thank you for being apart of our community!!

[@ArunKumar-ro7fc]

Could you explain different between claim adjudication and denial management?

[@InleraU]

Yes!! Recording this video this week :))

[@RT_SuperCollection__]

plz give a practical training using the practice management software like insync

[@janmejoysaml8511]

Thanks for giving knowledge on us Healthcare ajudication. I need more about. Please make a new video, How to. Process the claim, & which application are use.

[@InleraU]

Hi Jammejoy, Will do! Thank you, I will add these topics to my discussion list. Please let me know if you have any more questions or concerns.

[@ShiftyGearz]

Great video thank you. I herniated 4 disc on my 4th day at new company (old boss) and they based my compensation off a coworkers pay but coworker doesnt get o/t were as i get 10-20 o/t hours a week. I recieved an adjudication letter from md workrrs comp saying the rate & would be backdated however no one else seems to know about this letter. Kinda confusing. Lol

[@InleraU]

Thank you for your common! Yes, it’s just really a fancy way of them, saying that they are reviewing your claim against their policies and regulations.

[@onlineoffline2036]

Hi , do you have videos on how to properly fix denial codes? by the way all videos are very useful to me.

[@InleraU]

Yay!! :-)) So happy to hear you gaining value from the videos. I do not have any denial codes resolution videos up yet but its in the plans. Until then I would suggess joining the Medical Billers Network Facebook group and the ZOom Meetups as they cover denial resolution quite often.

[@sivavariyath]

We welcome you Mam

[@InleraU]

Thank you for the kind words!

[@g.r-eagle7443]

TY would love some information on doing transportation claims if this is possible. ty

[@InleraU]

I will see if I can get someone on for that specialty.

[@saisahruth7986]

Can we consider, accepeted for adjudication as Claim is in Process?

there’s something i did not get. You mentioned in a previous video that Denial happened after Adjucation and Rejection when the clearinghouse rejects the claim, but you mentioned here that last step of adjudication is approve or denial. Do you think you can tell me where I am wrong?

[@dbilbrew1431]

Great video, it was great how you broke the process down in common terminology. You may have already posted on "BALANCING UB's and 1500's"... If you have, please provide that link. If you haven't, would you please consider doing so? I am ever learning my career and I am attempting to excel more and more as it evolves. Thanks

[@InleraU]

Thank you so much for your comments.

[@benigwe8279]

Thank you

[@InleraU]

You are very welcome!! 🙌🏾

[@aftabzamanvlogs1390]

Great infos, thanks for this video. Can you kindly make a video regarding comparison between (Claims Adjudication, ITS Adjustment and IQT) too..

[@InleraU]

You are so very welcome! :) Thank you for the compliment of watching them. I have added this topic to our list of videos to release soon. Thanks!

[@aftabzamanvlogs1390]

@@InleraU My pleasure, eagerly waiting for the mentioned topic videos 😊👍🏻

[@100Bubbie]

I am a Pharmacy Tech and it baffles the mind how many patients dont bother asking if a new RX needs a prior authorization from the prescriber. It slows down dispensing to a crawl for many 🙄🙄🙄🙄

[@InleraU]

It can be frustrating, but it is important to remember that patients might not have the knowledge that some of us do. That's why we want to educate people not in medical careers, because everyone can benefit!

[@karthikmurali1004]

What is 820 EDI transaction set ? And how do we track denials in this transaction set Thanks for your support 🙏

[@InleraU]

Thank you for you comment! Is 820 EDI a US healthcare ANSI EDI Transaction? I'm not sure how this information is relevant for the healthcare business management or revenue cycle management.

[@prathapn01]

May I know, why not step2 is not performed first instead of step1. If the policy submitted doesnt exist in the system there is no need to go any further to check. correct me if I am wrong.

[@SunilPal-dl9sc]

Commercial claims under contract and non-contract provider TFL how many days.

[@InleraU]

Sorry that is dependent upon the insurance carrier. You can Google to obtain most of that information.

[@dxnsheger972]

Thanks

[@InleraU]

You are so very welcome 🤗

[@deehen9844]

She left out the side for the patient participation or agreement.

[@InleraU]

We will put that on our list for the next time we cover adjudication. Thank you for the suggestion!!

[@TDOGGYDOGG6983]

Beautiful Wifey 💓👑! How are you Queen?

[@InleraU]

Great :)