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Claims Adjudication Process

Boost revenue with ramped up claims adjudication processes

3X

Accuracy

24/7/365

Support

30+

Years of 
experience

Efficiently optimize provider payments to ensure member satisfaction

PCH Health's claims adjudication solution is designed to revolutionize how payers manage claims processing.

Leveraging over 30 years of industry expertise, our experts ensure accurate and timely determination of benefits, provider payments, member liabilities, and plan responsibilities.

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Automated processing

Automated processing

Automated tools streamline processing, including coding, data entry, decision-making based on predefined algorithms and rules.

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Integration with data sources

Integration with data sources

Easy integration with multiple data sources, such as provider contracts, regulatory information, patient records, and policy details, for accurate claim assessments.

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Fraud detection

Fraud detection

Advanced fraud detection algorithms spot suspicious behaviors and patterns to prevent financial repercussions.

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Transparency and efficiency

Transparency and efficiency

Automated claims adjudication processes foster trust among policyholders and providers, enhancing process efficiency.

Why PCH Health?

With decades of expertise and a commitment to innovation, PCH Health ensures precision and reliability in every adjudication decision.

Our tailored solutions are designed to meet payers' specific needs, enhancing member satisfaction, efficiency, and cost savings.

Why PCH Health?

Our delivery capabilities and performance benchmarks

PCH Health's claims adjudication solution streamline payment through meticulous assessment and resolution

193M+

Lives supported

30%

Reduction in pended claims

100%

HIPAA Compliant

Why opt for PCH Health’s claims adjudication solution?

Why opt for PCH Health’s claims adjudication solution?

  • HIPAA-compliant organization
  • Highly trained staff
  • Transparency and efficiency
  • Payment accuracy
  • Provider engagement
  • Fraud detection

Awards and Certifications

Major Player
NelsonHall
PEAK Matrix Medical
Peak Matrix Healthcare

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