What is the third stage of the life cycle of a claim?

What is the third stage of the life cycle of a claim?

• A. Claims adjudication
• B. Submission
• C. Payment posting
• D. Denial management

Answer: (A)

Understanding the claim life cycle starts with submitting the claim, then having it reviewed by the payer, and finally posting the payment. The third stage is adjudication, where the payer evaluates the claim against benefits, coverage, medical necessity, and coding rules. During adjudication, the payer decides how much of the claim will be paid, what portion might be denied, and the reasons for any adjustments. This step translates the submitted information into a payer decision and sets up the subsequent payment posting if the claim is approved. Denial management comes into play after a denial is issued, handling corrections or appeals, while payment posting occurs once the adjudication decision is made.

Understanding the claim life cycle starts with submitting the claim, then having it reviewed by the payer, and finally posting the payment. The third stage is adjudication, where the payer evaluates the claim against benefits, coverage, medical necessity, and coding rules. During adjudication, the payer decides how much of the claim will be paid, what portion might be denied, and the reasons for any adjustments. This step translates the submitted information into a payer decision and sets up the subsequent payment posting if the claim is approved. Denial management comes into play after a denial is issued, handling corrections or appeals, while payment posting occurs once the adjudication decision is made.