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Healthcare Claims Adjudication Services

Medical Claims adjudication can become extremely messed up, if you do not attach efficient processes to manage it. Such a mess can cause unwanted claims, duplicated claims, delayed execution, and, eventually affect your profits. You can choose to streamline your healthcare claims adjudication by choosing to work with Flatworld Solutions. We at Flatworld are experts in providing claims adjudication services for our global clients in the healthcare/medical insurance industry.

The entire process of receiving medical claims, verifying them and settling the claims forms a huge chunk of insurance processing task. Instead of running these routine and non-core processes within your organization, you can leverage our expert claims services. Our dedicated team of claims adjudicators and claims analysts will support you through the entire claims adjudication process in the same way an in-house team would do.

Read some of the answers to the frequently asked questions by our customers.

Our Healthcare Claims Adjudication Process:

Receive Claims Data
Receive Claims Data from You
Check for Eligibility
Check for Eligibility
Avoid Duplicate Claims
Check to Avoid Duplicate Claims
Benefit Determination Application
Benefit Determination Application
Analysis of Hospital Details
Analysis of Hospital Details
Diagnosis Review
Coding, Bundling & Diagnosis Review
Rules-Based Edits
Rules-Based Edits
Claims Settlement
Claims Settlement
Claims Presentment
Claims Presentment

Healthcare Claims for Which We Provide Adjudication Services:

  • HCFA claims 1500 / CMS1500
  • UB92 (Single / Multi / Attachment / COB)
  • UB04
  • Dental Claims
  • RX claims
  • Medicaid
  • Foreign claims
  • Superbill
  • Medicare RP
  • Miscellaneous (complex / non-standard)
  • Pends / Correspondence
  • Enrollment Forms Processing (EFP)
  • Vision Claims

What Makes Flatworld Different from Other Claims Processing Outsourcing Companies?

  • Our claims adjudicators are experts in healthcare claims processing and process your claims with efficient analytical skills, and not like a mindless activity
  • Our adjudicators are specifically trained in US healthcare adjudication systems and processes and provide dedicated healthcare BPO
  • We know and understand the intricacies of International insurance regulations and work according to your specific needs, in compliance to international healthcare claims standards and regulations
  • We provide maximum efficiency, quick turnaround time, accurate recording and up-to-date maintenance of records
  • You can be totally confident about the security of your data as we follow stringent data security systems and legally binding security policies

Take the first step towards tension-free and streamlined healthcare claims adjudication, by outsourcing medical claims administration of your organization to us.



Pricing is a critical factor to consider before outsourcing. Our pricing model allows you to keep your costs in control.

Case Studies

Case Studies

Read Case Studies to find out how we helped our clients with Healthcare BPO.

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