Claim Pricing in Claim Adjudication Process

The claim adjudication process is a critical function within healthcare organizations, determining the legitimacy and value of claims submitted for payment. This paper explores the pricing logic applied during claim adjudication, focusing on the algorithms and methodologies used to evaluate claims effectively. By analyzing the impact of pricing logic on the overall efficiency and accuracy of claim processing, this study aims to provide insights that can enhance healthcare reimbursement practices and improve operational efficiency. Keywords – Claim Adjudication, Claim Pricing, Healthcare Organization, Reimbursement, Algorithms.