Streamline claims processing and reconciliation

Claims Adjudication

Claims adjudication from Netsmart uses a business rules engine and automated claims matching to simplify claims processing for state agencies and managed care organizations (MCOs). The web-based solution integrates with electronic visit verification (EVV) applications and electronic health records (EHRs). Claims data is aggregated into a dashboard, making it easy to review all claims information at a glance.

Claims are pre-screened, scrubbed and put in a standard format. Matched claims are automatically transmitted for processing with no manual intervention. Unmatched claims can be resolved and resubmitted. Adjudication data is easy to import to reconcile claims status and resubmissions are easy to document and track.



A web-based solution for state agencies and MCOs that integrates with EHRs and EVV applications to automate claims adjudication and claims error processing.

  • Integrates with provider EHRs and EVV applications and aggregates claims data into a dashboard
  • Business rules engine to pre-screen claims
  • Scrubs claims and provides all claims submissions in a standard format
  • Automatically transmits matched claims
  • Resubmissions are easily documented and tracked
  • Near real-time processing speeds payment of claims
  • Reduces manual processing and increases efficiency
  • Provides financial insights through reconciliation of claims status

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