Claim refused or subject to limit #51

The strength behind an adjudication system lies obviously on its capacity to refuse payment of a claim when one's file does not comply with the required approval criteria.

Following are different scenarios in which the system establishes the non payment of a claim by automatic adjudication.

Likewise, it is possible to manage the limited amounts payable for each process and service rendered.

To allow for management of such conveniences, it is essential for the operator and the claim administrator to process the information within the business rules administration module.

Now that he has a better understanding, the knowledge and the capacity to process through Allegroupe, the operator more easily can analyse the information when consulting an array of listed items from a specific batch.

It will then be much easier for him to appreciate the limit introduced by the Allegroupe's adjudicator. Finally, the information always remains available on the top right hand corner as well as the bottom of the screen for the operator to have access to a comprehensive information on how to Allegroupe adjudicator managed each item from a batch or, the whole batch.

We can browse through other examples where Allegroupe will adjudicate a claim based on the limited amount payable for a particular service.

In order to provide some assistance to the administrator, the operator can capitalize on the collaborative concept strength which exists with C-surance since many of the usual rate listing will be automatically managed by professional assigned to this task for the overall interest of the clientele.