Revenue cycle management / TERM EXPLAINED
Claim Adjudication
The evaluation of a claim against eligibility, coverage, coding, network and payment rules to determine its disposition.
A dental practice example
A claim passes eligibility checks, receives an allowance and is assigned cost sharing.
Why it matters for reimbursement
Multiple processing steps determine actual payment beyond a published negotiated rate.
What to verify
Use adjudication details to explain variance before alleging rate-loading errors.
FROM DEFINITION TO DECISION
Turn reimbursement questions into evidence.
PayorMap helps dental groups connect disclosed negotiated rates, provider and network context, and contract details to meaningful benchmarking questions. Coverage and mapping confidence vary by payor and market.