Adjudication is the process by which:
A) a claim is paid in a timely manner.
B) a claim is reviewed and payment decisions are made by the payer.
C) data are entered into an electronic file or account.
D) a healthcare provider is sued by a patient.

Question

Quizplus · Accepted Answer

Adjudication is a process that involves reviewing a claim and making a decision on whether or not to pay it. The payer or insurance company is typically the one responsible for adjudicating claims. This process involves verifying that the claim is valid and that the services or procedures provided are covered under the patient's insurance plan. Once the claim has been adjudicated, the payer will either make a payment to the healthcare provider or deny the claim.

Adjudication Is the Process by Which