- High Throughput Processing
- Compliance & Audit-Ready
- Denial Management & Appeals
Comprehensive Claims Management for Health Plans
Valiant Lifecare delivers focused ED coding services that address the high-volume, high-complexity environment of emergency care. Our teams ensure correct E/M level assignment (99281–99285), critical care capture, procedure coding, observation/observation conversion rules, and documentation that supports claims and audits.
Our Claims Management Services
Claims Intake & Validation
Receipt, data validation, eligibility checks, and clean claim preparation before adjudication.
Adjudication & Processing
Rule-based adjudication, payment calculation, and benefit coordination according to plan guidelines.
Denial Management & Appeals
Root-cause analysis, documentation gathering, appeals submission, and denial follow-up to maximize recoveries.
Remittance & ERA Reconciliation
Payment posting, adjustment reconciliation, and accounts reconciliation for accurate financials.
Provider/Member Claims Support
Communication handling, support for inquiries, corrections, and resubmissions.
Audit & Compliance Review
Periodic audits for coding compliance, regulatory alignment, and fraud prevention.
Analytics & Reporting
Custom reports: denial patterns, payment turnaround, claim lifecycle metrics, cost trends and utilization analysis.
Custom Rules & Configuration
Plan-specific benefit rules, coverage logic, and payer edits customized to your policies and contracts.
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How Our Claims Management Workflow Works
Claims Receipt & Triage
Intake via EDI, portal, or manual submission; initial eligibility and data validation.
Data Validation & Clean Claim Prep
Verify coding, demographic data, modifiers, and coverage rules before adjudication.
Adjudication & Payment Processing
Apply benefit rules, edits, coordination of benefits, and payer-specific logic.
Remittance & Reconciliation
ERA/EDI reconciliation, posting, adjustment handling, and reporting.
Denial Handling & Appeals
Identify denials, root-cause analysis, documentation review, resubmit claims/appeals.
Analytics & Reporting
Generate dashboards and reports on denial rates, claim turnaround, payment velocity, and utilization trends.
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