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 the health plans and Third-Party administrator. 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 to 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, CMS regulations understanding, and other health plan needs.

Netmark Business Services goals is to be claim director’s partner to help with efficiencies of competitiveness.

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Frequently Asked Questions

Netmark prides itself on its deep expertise on multiple platforms like QNXT, AMISYS, FACETS, HPS 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 and deny claims. So, inventories, backlogs and appeals are inevitable. Processing appeals can cost claim directors a lot of money per claim as only the ablest and most experienced examiners can work on appeals. Netmark has taken that responsibility off of most claim directors and offers a per-appeal processed dollar number 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.

In addition to examination and adjudication help, we have a team of experienced retired claim directors who can act as a SWAT team to handle backlogs, for streamlining teams and work on CMS Corrective Action Plans. They have the experience and gravitas to speak to plans C level leadership to enable and augur change. We also work with plan leadership on reporting and analytics, root cause analysis and on improving core systems.