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Our medical claim examiners will perform adjudication to eliminate fraud, reduce expenses, and enhance your productivity at affordable rates. End your woes at once by outsourcing claims adjudication services to Meg World IT Services. We have ramped up efforts to fight fraud, increase productivity, and boost revenue with our claims adjudication services.

Whether it is manual or electronically submitted claims we will scrutinize the claims record to ensure accuracy in patient names, diagnostic codes, and process claims that are valid and reimbursable. Our medical claim examiner will closely examine claims after the application of insurance and reject ones that are partially fulfilling, duplicate, or erroneous. Our diligent claims adjudication practices will speed up claims execution and help you contain risks that impact your profit.

Healthcare Claims Adjudication Services We Offer


hours tat




Cost Reduction




Years Experience

Why Outsource Healthcare Claims Adjudication Services to Meg World IT Services ??

Healthcare Claims Adjudication Process We Follow

Initial Processing Review

In the first step, the claims are thoroughly checked for errors and omissions. The claim can be corrected and resubmitted for payment when the claim is rejected for any of the following reasons - Incorrect or wrong patient name, Incorrect place of service code , Wrong date of service , Invalid or missing diagnosis code

Automatic Review

In this step, claims are checked in detail for items which apply to the payment policies. The issues identified during the automatic review include -Eligibility of the patient on the date of service , Absence of authorization and pre-certification , Invalid authorization and pre-certification .

Manual Review

In this step, medical claim examiners check the claims manually. It is common for nurses and doctors to perform manual checks and compare the medical documentation with the claims. This step is performed for any type of medical procedure and is especially done for a procedure which is not listed.


The payment submitted by the insurance payer to the medical care provider is referred to an explanation of payment. It includes the following data -Allowed Amount , Covered Amount , Patient Responsibility Amount , Approved Amount , Discount Amount , Adjudication Date.

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