Processes

Agree on post-adjudication approach and technology

How agree on post-adjudication approach and technology are reshaped as AGI capability advances.

ProcessesAgree on post-adjudication approach and technology
Agree on post-adjudication approach and technology — illustrated

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How the work flows

Trigger: A strategic review or modernization initiative targeting the post-adjudication phase of claims processing is initiated.

  1. Review existing post-adjudication workflows and system gaps
  2. Define business and regulatory requirements for payments, EOBs, and appeals
  3. Evaluate internal capabilities against external technology vendors
  4. Select the preferred technology platforms and operational models
  5. Secure stakeholder consensus and budget approval
  6. Document the finalized post-adjudication strategy and technology roadmap

Outcome: An approved framework and selected technology stack for executing post-adjudication activities are established and ready for implementation.

Measured by

Strategy Development Cycle TimeRequirements Coverage RatioTechnology Acquisition CostStakeholder Approval Rate