groupSource has been adjudicating health and dental claims on behalf of partner underwriters since 1989.
Claims adjudication is the application of group policy guidelines and provisions to pay claims. It involves personal medical information which requires privacy and confidentiality protection.
This is achieved through:
Our claims adjudicators
who process claims and answer inquiries about specific claims issues in a timely manner as well as research discrepancies and contact providers to obtain missing information
adjudication to the highest standards
without prejudice and verified by regular internal and external claims audits to ensure quality and consistency
Our claims services ensure:
Turnaround of 2 working days
standard claim turnaround time of 2 working days upon receipt of claim
Explanation of benefits
payment with an Explanation of Benefits indicating eligible and ineligible items
and confidentiality of personal claim information
that conform to Customs and Revenue Agency to protect the tax-exempt status of benefits paid from private health plans.