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adjudicated. 1  transitive verb. : 2  to make an official decision about who is right in (a dispute) : to settle judicially The school board will adjudicate claims made against teachers. 3  intransitive verb. : 4  to act as judge The court can adjudicate on this dispute.
Claims Processing: What is Claims Adjudication? Posted by Apex EDI on January 19, 2017 . After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider. When an insurance company decides to reduce a payment to the provider, they have determined that the billed service level isnât appropriate for the diagnosis or procedure codes.