Common Claims Adjudication Errors: Their Cost and How to Fix Them

Overview

Even small claims adjudication errors can create significant financial leakage, member dissatisfaction, provider abrasion, and compliance risk. This article explores the most common errors and practical strategies to eliminate them.

Key Topics

• Incorrect benefit configuration
• Eligibility discrepancies
• Duplicate claim payments
• Coding inaccuracies
• Coordination of Benefits errors
• Impact on medical loss ratio and administrative costs
• Audit and monitoring best practices
• Using automation to improve accuracy

Take the Next Step

Learn how Netmark helps plans identify and correct adjudication issues before they become costly problems.