Claims Processing (For TPA/IPA or similar industry)

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OutsourceBiz can handle the entire claims adjudication process for clients, providing cost savings, increased accuracy, and faster turnaround times. With personnel at our BPO Center that are trained to understand medical claims repricing and adjudication, we can handle all functions in the claims processing cycle:

  • Claims receipt, sorting, and scanning
  • Data Entry (Dual Entry Validation 99% accuracy)
  • Repricing
  • Adjudication
  • Claims conversion to EDI
  • Workers Compensation Paper Claims
  • Claims data archival and retrieval

Claims Processing Workflow





Clients are offered flexibility in terms of how much or how little of the actual claims processing workflow they want to outsource.

At the most basic level, our BPO Center can perform all data entry for you using our Dual Data Validation method and produce EDI files which are compatible directly with your claims system.

At the most advanced level of our claims outsourcing service, our BPO Center will manage all aspects of the claims processing workflow for you including repricing and adjudication functions.


HIGHLIGHT: DUAL VALIDATION

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To achieve optimal accuracy, our BPO Center utilizes a system for data entry validation called Dual Validation. Using Dual Validation, our BPO Center requires all claims to be entered IDENTICALLY by two separate data entry operators. If both operators do not enter the exact same information for the claim, then the claim data entry is rejected and the operators are asked to perform the data entry process again. This process enables us to provide 99% or better accuracy in our data entry process, ensuring that fewer claims are rejected during adjudication.

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