Adjudication

Datacap outputs claim images to a document image or content management system, but what of the data that has been read off the claims? Most often that data goes to an adjudication system which decides whether to pay a claim and, if so, how much to pay. Thanks to the government-adopted Healthcare Information Portability and Accountability Act (HIPAA), there is now a standard format to communicate medical claim data - the ANSI X.12 837 committee's 4010A revised format, usually referred to an "837 file". Once claim data has been recognized and verified, then our medical claims processing software outputs an 837 file - or other format as required. The data then loads into an adjudication system used by the payor:

Erisco

Trizetto

Epic

HSD Diamond

OAO

RiMS

QICS

Learn more about Taskmaster for Medical Claims