What Happens After Adjudication? | Insurance Claims Processing
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- Опубліковано 9 лют 2025
- In this video, Jasmine from IPS Learning Institute discusses what happens after the adjudication of claims in medical billing. She also reviews the 3 potential outcomes of adjudication of claims by an insurance carrier.
Do you have a question about the revenue cycle or the business of healthcare? Drop your question below! #Medicalbilling #adjudicationofclaims #afteradjudication
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❓❓ Do you have a question about the revenue cycle or the business of healthcare? Drop your question below! #revenuecyclemanagement #revenuecycle #medicalbilling
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P.S. We want to give you more of what you want. What more do you want to learn about healthcare? Share your topics in the comments below!
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Who is Jasmine?
A natural-born leader, Jasmine believes in creating a work environment that is fulfilling to its team both personally and professionally. With over two decades working in the healthcare industry, she leverages her experience and passion for people to help guide the next generation of medical billers. By implementing new processes that have proven to be both efficient and effective, she’s able to help scale organizations to new levels.
Jasmine works as a healthcare advisor and speaker to ensure her core mission of alleviating the stress and confusion from the business side of healthcare improves the patient care process. She is a master at developing systems that position an organization to grow while delivering exceptional services to its clients and patients. Jasmine has been able to reach new heights with her business by living a life full of passion and purpose.
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
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!
Ty so much for your very informative explanations! I can understand a lot of these terms more easily because of you😊
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!
@@InleraU ty because you've helped so much
Very interesting video :D Thanks for sharing !
Thanks! So happy you found it helpful :)) What other healthcare topics are you interested in learning about?
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?
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)
I've been adjudication process for over 8 weeks. Now they tell me about some escalation process. Its always something. Can you explain why
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.
I appreciate your detailed explanations regardless of the subject :)
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.
How much a normal people get paid in US or anywhere in claim Adjudication with a year of experience?
I know very little about the claim djudication position as that takes place on the insurance carrier end.
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 🥺
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.
Please make a video on disability insurance adjudication
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.
I want to get more from
You
We're happy to hear that! Is there anything specific you want to learn about?
****QUESTION Veteran Adjudication*****
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.