Aaseya Claim Adjudication
Solution Overview
The Claim Adjudication Application is a comprehensive digital solution designed to streamline the process of evaluating, processing, and resolving insurance claims. It enhances efficiency, reduces manual errors, and ensures compliance with industry regulations while improving the adjudicator and supervisor's experience.
Key Features
- Provides a detailed view of claim information, including policyholder details, claim history, facility, billing and collection.
- Automatically assigns claims to adjudicators based on their region, and predefined rules.
- Allows resubmission of claims with corrected or additional information after rejection.
- Maintains an audit log for all rebilled claims to track modifications and adjudication history.
- Provides adjudicators with the ability to reject claims based on policy violations, incomplete documentation.
- Enables adjudicators to filter claims based on multiple parameters, such as claim type, status, provider, adjudication stage, and amount.
- Allows users to save and reuse frequently applied filters for efficiency.
- Allows sorting claims based on priority, submission date, claim amount, or adjudication status.
- Provides a built-in help request feature where adjudicators can seek guidance on complex claims.
- Offers a visual dashboard displaying claims data segmented by geographic regions.
Key Benefits
- Profile-Based Claim Assignment to Adjudicator
- View Claim Details
- Rebill Claim
- Reject Claim
- Custom Filter
- Custom Sorting
- Help Request for Claim Adjudication
- Dashboard to Review Region-Wise Claims