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© 2026 IJSREM – International Journal of Scientific Research in Engineering and Management. This is an open-access journal. Articles are published under the Creative Commons Attribution (CC BY 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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ArticlePeer ReviewedOpen AccessPlagiarism Passed
Paper ID:10.55041/IJSREM8808

Claim Pricing in Claim Adjudication Process

Stream/Area:

-

Subject:

-

Paper ID:

10.55041/IJSREM8808

Volume:

5 |

6 |

Jun 2021

Pages:

Publication Frequency:

Monthly (12 issues per year)

DOI
Digital Object Identifier
10.55041/IJSREM8808

License:International Journal of Scientific Research in Engineering and Management follows the Creative Commons Attribution 4.0 (CC BY 4.0) License, allowing free use and distribution with proper attribution.

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PKV

Praveen Kumar Vutukuri

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Abstract

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

Cite This Article

Praveen Kumar Vutukuri, "Claim Pricing in Claim Adjudication Process," International Journal of Scientific Research in Engineering and Management, vol. 5, no. 6, Jun 2021. https://doi.org/10.55041/IJSREM8808

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Publication Date

6/10/2024

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Double-Blind Peer Review

Review Rounds: 2

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The authors declare no conflict of interest related to this research work.

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No funding information available for this research.

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