After a third-party payer validates a claim, which of the following takes place next?

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Multiple Choice

After a third-party payer validates a claim, which of the following takes place next?

Explanation:
After a third-party payer validates a claim, the next step is adjudication. Adjudication is the payer’s processing phase where they apply contract terms, eligibility, coverage, coding rules, and benefit limits to determine how much, if anything, will be paid. It results in a payment decision (paid, partially paid, or denied) and often a remittance advice that explains the calculation. Payment posting happens only after adjudication confirms the payment amount, or after a denial is determined, and patient statement generation typically occurs after payment posting or once any patient responsibility is known. So adjudication is the immediate next step because it sets the actual payment or denial outcome that drives the rest of the workflow.

After a third-party payer validates a claim, the next step is adjudication. Adjudication is the payer’s processing phase where they apply contract terms, eligibility, coverage, coding rules, and benefit limits to determine how much, if anything, will be paid. It results in a payment decision (paid, partially paid, or denied) and often a remittance advice that explains the calculation.

Payment posting happens only after adjudication confirms the payment amount, or after a denial is determined, and patient statement generation typically occurs after payment posting or once any patient responsibility is known. So adjudication is the immediate next step because it sets the actual payment or denial outcome that drives the rest of the workflow.

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