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Dr. Eric Bricker discusses health insurance claims adjudication in this episode of A Health Care Z. He emphasizes the importance of understanding this process for those in healthcare, employee benefits, and insurance. A claim is initially submitted by a provider and is later paid by the insurance company; the steps between submission and payment constitute adjudication. Auto adjudication, where software manages 85% of claims without human intervention, minimizes costs compared to manual processing, which can average around twenty dollars per claim. Understanding this efficient system is crucial due to the high volume of claims processed in the healthcare industry.
