Adjudication & Adjustment Services
Accurate, efficient claims processes at scale.
Sagility combines tech-enabled workflows and experienced claims specialists to help health plans process claims correctly the first time and resolve needed adjustments quickly and in full regulatory compliance.
Overview
As part of Sagility’s Claims & Membership Management Suite, our Adjudication & Adjustment Services ensure claims are processed accurately, timely, and in compliance with all regulations. We apply rules accurately, identify exceptions that require expert review, and complete adjustments with policy-aligned execution and provider/member-friendly communication.
Adjudication
- Claims intake, validation, and eligibility checks
- Accurate application of benefit and policy rules
- Automated and manual exception handling
- Real-time and batch adjudication capabilities
Adjustments
- Underpayment and overpayment correction
- Secondary/coordination of benefits (COB) adjustments
- Auditable reprocessing workflows
- Provider and member outreach as required
Decades of Partnership, Performance, and Progress.
Clients stay with Sagility for a reason: deep-domain expertise, measurable outcomes, and a true partnership approach. Purpose-built for healthcare and trusted by the nation’s top health plans and providers, we bring decades of experience and a proven ability to simplify operations and deliver lasting impact.
Straight from the Source
We’re more than a vendor, we’re a partner. Here’s what our clients have to say:
Sagility invests time to understand our business and develops innovative solutions that would not be possible without their deep operational knowledge.
Payment Integrity Lead,
National Health Plan
They are technology-enabled but prioritize business and partner outcomes above all else. It is not about promoting tools for their own sake — Sagility thoughtfully applies a broad range of capabilities to deliver solutions that drive measurable results. They truly put the client first.
Executive Director, Business Operations,
Healthcare Financial Services Company
The implementation was seamless, and their support team is outstanding. We’ve achieved 98% accuracy in claims processing and reduced our days in A/R from 45 to 28. Their technology is truly game-changing for healthcare providers.
Revenue Cycle Director,
Multi-specialty physician group
Case Studies
See how we’ve helped payers unlock millions in savings and streamline operations:
Insights & Resources
Stay informed with the latest thinking on healthcare payer operations:
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Let’s explore innovative solutions tailored to your needs—and get more done, together.