The purpose of the Claim Adjudication Manual is to enhance the capacities of the adjudication team to ensure accurate and timely processing and settlement of claims under BSKY,  and improve the ability to efficiently combine fundamental concepts, system functionalities, and human intelligence during claim adjudication.

Accurate processing is crucial in various aspects, including verifying eligible claims, approving precise amounts to EHCPs, and genuine utilization of the beneficiary wallet. This manual will help Claim Processing Doctors (CPD) and State Nodal Doctors (SND) efficiently and accurately adjudicate pre-authorizations and claims while exercising due diligence. Each defined process has a timeline associated with it. This manual explains the roles and responsibilities of the personnel involved in the BSKY claim adjudication workflow.