Year: 2024
Type: article
Abstract: The claim adjudication process is a critical function within healthcare organizations, determining the legitimacy and value of claims submitted for payment. This paper explores the pricing logic applied during claim adjudication, focusing on the algorithms and methodologies used to evaluate claims effectively. By analyzing the impact of pricing logic on the overall efficiency and accuracy of claim processing, this study aims to provide insights that can enhance healthcare reimbursement practices and improve operational efficiency. Keywords – Claim Adjudication, Claim Pricing, Healthcare Organization, Reimbursement, Algorithms.
DOI: 10.55041/ijsrem8808
Author: Praveen Kumar Vutukuri
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4404104537