Claims Intake & Validation
Receipt, data validation, eligibility checks, and clean claim preparation before adjudication.
From claims intake and adjudication to denial resolution and reconciliation — Valiant Lifecare delivers complete claims management with compliance, audit readiness, and custom rule configuration.
Receipt, data validation, eligibility checks, and clean claim preparation before adjudication.
Rule-based adjudication, payment calculation, and benefit coordination according to plan guidelines.
Root-cause analysis, documentation gathering, appeals submission, and denial follow-up to maximise recoveries.
Payment posting, adjustment reconciliation, and accounts reconciliation.
Communication handling, support for inquiries, corrections, and resubmissions.
Periodic audits for coding compliance, regulatory alignment, and fraud prevention.
Custom reports: denial patterns, payment turnaround, claim lifecycle metrics, cost trends.
Plan-specific benefit rules, coverage logic, and payer edits customised to policies and contracts.
Intake via EDI, portal, or manual submission; initial eligibility and data validation.
Verify coding, demographic data, modifiers, and coverage rules before adjudication.
Apply benefit rules, edits, coordination of benefits, and payer-specific logic.
ERA/EDI reconciliation, posting, adjustment handling, and reporting.
Identify denials, root-cause analysis, documentation review, resubmit claims/appeals.
Generate dashboards and reports on denial rates, claim turnaround, payment velocity.