What is the correct order for the basic steps of a payer's adjudication process?
A) initial processing, automated review, manual review, determination, and payment
B) initial processing, manual review, automated review determination, and payment
C) manual review, initial processing, automated review, determination, and payment
D) automated review, initial processing, manual review, determination, and payment

Question

Quizplus · Accepted Answer

The correct order for a payer's adjudication process typically starts with initial processing to check for basic requirements and errors, followed by automated review to apply rules and policies automatically. If necessary, a manual review is conducted for complex cases or issues not resolved by automation. After reviews, a determination (approval, denial, or request for more information) is made, leading to the final step of payment processing if approved.

What Is the Correct Order for the Basic Steps of a Payer's