Claim Adjudication for Health Plans

Services

Claim Adjudication for Health Plans

Do you need to catch up on processing and determining the validity of your health insurance claims? Or do you have a high number of claims that have been pended?

Netmark Business Services offers expert assistance with experienced examiners, adjusters, provider reconsideration specialists, and appeal adjudicators for health plans, health systems, and TPAs.

Why put the stress of handling claims on your internal claim staff when you can have an entire claims team working alongside them? By outsourcing to a team specializing in claims processing, you’ll experience fewer errors in the examination process, greater efficiency in the number of claims processed, less expensive and more flexibility in adjusting to your business’s needs.

claim health
  • FACETS
  • QICLINK
  • QNXT
  • DIAMOND
  • DST
  • AMISYS
  • JAVELINA

This extensive experience and knowledge enable us to efficiently and effectively process claims, ensuring to be handled promptly and accurately. We are dedicated to providing the best service possible to our clients and are constantly updating to keep up with the latest industry developments.

Netmark’s team of experts can offer professional audit services for processed and pending claims to improve efficiency and productivity. These services include reviewing and analyzing claims data, identifying errors or discrepancies, and providing improvement recommendations.

Netmark’s expert examiners can provide specialized audit services for both processed and pending claims to improve efficiency and increase overall throughput.

Our primary objective is to serve as the go-to claims examining office for health plans and TPAs. We understand the importance of maintaining a long-term relationship with our clients and strive to be a trusted partner to the health plans and TPAs we work with.

We also offer “Clutch” services for clients who need to clear backlogs within a short timeframe. Our team has over 15 years of experience working with various health insurance companies and Fortune 500 self-insured plans, which allows us to analyze our client’s needs and provide customized solutions to keep them competitive in the industry.

Our expertise includes claims adjudication, member benefits, and a deep understanding of CMS regulations and other health plan needs. We are committed to providing our clients with the support they need to succeed, and we look forward to building a lasting partnership with Claims directors.

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Frequently Asked Questions

Netmark prides itself on its deep expertise on multiple platforms like QNXT, AMISYS, FACETS, HSP among others. Netmark’s bench of expert examiners and appeal experts can truly help reduce claim inventory substantially in a matter of days.

All software pend a deny a percentage of claims while auto adjudicating a majority of claims. Backlogs and appeals are inevitable. Processing appeals are expensive as only the smartest and most experienced examiners can work on appeals. Netmark can offer extremely experienced appeal processors and offers a per-appeal processed price that helps the claims processing department stay within or under budget. Give us a call or email us at [email protected] for a quick conversation.

All software pend a deny a percentage of claims while auto adjudicating a majority of claims We offer…

Provider call centers manned by experienced adjudicators with knowledge of navigating complex adjudicating software

Experienced retired claim directors who can act as a SWAT team to handle any complex claims issue

Plan configuration – Am experienced team of claim configurators who can work with your actuaries and configure