Claim Audit and Recovery


Claim Audit and Recovery

Claim audit and recovery services are important components of health plan and third-party administrator (TPA) services. These services involve reviewing medical claims submitted by healthcare providers to ensure that they comply with the terms and conditions of the health plan or TPA contract.

The objective of the claim audit is to identify and recover overpayments, duplicate payments, or other inaccuracies that may have occurred during the claim process. Claim audit and recovery services can also help to detect and prevent fraud, waste, and abuse within the healthcare system.

For instance, they can help to identify instances where healthcare providers are billing for services that were not performed or for more expensive services than were actually provided. By identifying these cases, the TPA can work with the healthcare provider to resolve the issue, thus reducing the risk of fraud and abuse.

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Netmark’s experienced professionals help to streamline the audit process, allowing for a more efficient and effective review of claims. Netmark’s claim audit and recovery services provide a valuable resource for health plans and TPAs seeking to optimize their financial performance and ensure compliance with industry regulations.

Our company’s combination of technology, expertise, and commitment to excellence has made it a trusted partner for many leading organizations in the healthcare industry.

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Frequently Asked Questions

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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