The claims payment process necessitates a second level of review, to address the provider appeals & ensure the appropriate payment on all claims. The ‘Claims Reconsideration’ process helps in dealing with claims that were under-paid / denied during initial submission for a variety of reasons, such as:

• Underpayments/denials due to the wrong application of contracted rates or terms
• Denied for Timely filing issues re-submitted with timely filing proofs
• Claims denied for additional information & re-submission with requested documents
• Claims denied for Prior authorization & re-submission with citing of contract exclusions, Emergency or pre-auth information
• Claims denied due to Enrollment maintenance issues such as COCC, COB status
• Claims received without primary insurance EOB & re-submission with EOB
• Claims re-submission with corrected data
• Claims re-submission of Bundled claims with supporting information
• Subrogation/Third party claims

How can Data Marshall Help?

Data Marshall has gained a unique perspective of the claims payment & settlement process, through expertise & experience of having worked on the Claims Adjudication, Overpayment/Underpayment Recovery. The ‘Claims Reconsideration’ services help in resolving the payment related issues from providers and members by performing appropriate adjudication functions and ensure a smooth claim settlement process.

Benefits

• Effective resolution of Claim settlement issues
• Avoid late payment penalties through timely resolution of claims in adherence to the TAT & statutory requirements
• Ensure good Payer-Provider relations
• Control the flow of claim resubmissions through inputs & insights provided, to streamline the Claim payment process

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