Auto Adjudication of Claims
Adjudication is the raison d’etre of all health plans. Adjudication ensures prompt payments to Providers. Auto adjudication helps automate these payments and makes the healthcare ecosystem into a well oiled machine. Netmark’s team of configurators and Subject Matter Experts help from gathering the right requirements to configuring the current system to suit the new needs of the health plan. The Netmark team manages the initial configuration of the Provider, Member and claim streams as well as work to create a real time Data Warehouse for data consumption by other ancillary services to the plan as in Print or Prior authorizations or member portals etc. Netmark takes charge of the adjudication platform as would the operations of the health plan and continues to tweak the Auto adjudication rate after go-live and after every year when the benefit configurations change and work as the BPO to handle pends and PDRs