Adjudicated Claims: Getting Claims Paid the First Time


Did you know the insurance industry pays out nearly $1.3 trillion in premiums each year?

When it comes to medical billing, it’s essential to avoid denied claims at all costs. Claims rejection can easily cause a number of issues in the future, such as delayed payments or legal consequences.

Claims adjudication is a process where the insurance company determines whether or not they are financially liable. Let’s take a look at a guide that can help ensure that your adjudicated claims are paid the first time they are submitted.

Provide as Much Supporting Documentation as Possible

When it comes to adjudicating claims, documentation is key. The more information you can provide upfront, the better.

Include everything from the patient’s medical history to test results and X-rays. If there are any discrepancies in the documentation, the claim is likely to be denied. It’s in your best interest to be proactive and reach out to the insurance company to determine what material they need from you.

Submit Claims Electronically

One of the best ways to ensure that your claims are paid quickly and without issue is to submit them electronically. This can help reduce the chances of human error, as well as speed up the payment process. Submitting claims electronically also establishes a permanent record of the submission.

Practice Good Communication

It’s important that you have a good working relationship with both your patients and their insurance providers. Communicating openly and honestly can help prevent any misunderstandings or issues when it comes to paying and submitting claims.

It’s also worth mentioning that you should always be respectful and calm during your communication with the insurance company. It’s not uncommon for people to become frustrated, but this can only lead to further complications down the road.

Don’t Hesitate

Some people put off certain obligations when it comes to the claims process. Unfortunately, this can lead to further issues down the road, including additional fees and penalties.

When it comes to submitting claims, you don’t want to delay the process any longer than necessary. The sooner that your claim is submitted, the better! This will go a long way in terms of helping ensure that your money is paid the first time.

Don’t Be Afraid to Ask for Help

If you’re having issues with your claims, it’s always a good idea to reach out for help. Many insurance companies offer assistance when it comes to submitting and paying claims.

It’s best to be proactive about this process and not let any issues go unresolved. By working closely with the insurance company, you can ensure that your money is paid quickly and without issue.

You can check out this resource to learn more about laboratory billing.

Handling Adjudicated Claims Is Easier Than It Seems

Although adjudicated claims can sometimes take a while to resolve, the above information can help ensure that you can avoid common pitfalls that you may otherwise encounter.

Looking for other useful information that can help you in the future? Be sure to check out our blog for articles like this one.