Claims Services

The Claims Services Department at TriSurant processes each claim with speed and accuracy. Our experienced claims processors are not only well trained in our claims system, but also have the procedures and knowledge to handle those claims that occasionally fall outside the guidelines for auto adjudication. They apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. When questions arise, they coordinate responses for routine phone inquiries and written correspondence related to claim processing issues. When our systems identify a questionable claim, it is the claims services staff who expedites the handling of claims flagged for more in depth review. Appropriate payment helps to reduce our clients’ claims costs and help their claims dollars to be spent wisely, and software helps us to find those claims which deserve closer scrutiny. The Claims Services Department is a vital link in this process.