Adjudication in Medical Billing
Adjudication is the process used by insurance companies to determine how much of a claim will be paid after reviewing it for accuracy and coverage.
Adjudication in Medical Billing Explained
During adjudication, the payer reviews the claim, checks the policyholder’s benefits, and determines whether the claim is valid and how much should be paid. The process ensures that claims are processed according to the terms of the insurance policy and that services were provided correctly.
For example, after a claim is submitted, the payer goes through adjudication to confirm what portion of the billed amount will be paid to the provider.
Understand acronyms and abbreviations in Medical billing glossary.
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