Services

Claim Adjudication for Health Plans

Are you behind on adjudicating your health claims? Or do you have a high pend rate? Netmark Business Services provides experienced examiners, adjusters, provider reconsideration experts and appeal adjudicators for health plans, health systems, and TPAs.

Why burden your in-house adjudicating staff when you can have an entire team working with with your team. A competent team with lower examining errors, higher efficiency on number of claims processed and more flexibility, all at a much lower cost?

Netmark Claim Examiners are experts in their field and collectively have processed millions of claims, with hands on knowledge and experience in multiple claims systems:

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

Netmark’s examiners can provide expert audit services in processed claims or pended claims to enhance throughput.

Have a Question for Us?

Our goal at Netmark Business Services is to be the claims examing office for health plans and Third-Party administrators. Our goal is to be a long-term trusted partner of the health plan / TPA. We can also provide “Clutch” services for three or four months to clear back logs. With over 15 years of experience with several health insurance companies and Fortune 500 self-insured plans, Netmark analyzes your needs and provides services for the plan / TPA to stay competitive. Our expertise includes claims adjudication, member benefits, understanding CMS regulations and other health plan needs.

Netmark Business Services aspires to be a dependable partner to Claims directors by providing competent claim examiners on demand.

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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