Which term refers to the electronic processing of claims with insurance companies and HMOs?

The term that refers to the electronic processing of claims with insurance companies and Health Maintenance Organizations (HMOs) is adjudication. In the context of health insurance, adjudication is the process through which claims are reviewed, decided upon, and paid by the insurer. This involves determining whether the services billed were covered under the patient's insurance policy and whether the amounts claimed are accurate and justifiable according to the plan's terms.

Adjudication streamlines processing claims to ensure that payment decisions are made efficiently and in accordance with established guidelines, which is crucial for maintaining smooth operations in healthcare billing and providing timely reimbursements to providers. This process often incorporates electronic data interchange (EDI) systems, facilitating the quick exchange of claim information between healthcare providers and insurers.

The other terms do not specifically relate to the electronic processing of claims in the same way. For instance, advance-fee loans relate to financing, while adjustments generally refer to changes made to accounts or claims after they have been processed, but not the initial processing itself. Automated accounting devices pertain more broadly to accounting systems rather than the specific context of claims processing in healthcare.