Health Insurance Claims Processing

What is health insurance claims processing? The medical billing insurance claims process starts when a healthcare provider treats a patient and sends a bill of services provided to a designated payer, which is usually a health insurance company.
 
Patient demographic data and insurance information are added to the bill, and the claim is ready to be processed. What is the claims adjudication process?
 
After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider.
 
This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider.