TPA Adjudication Services

Netmark Business Services’ claim adjudication services for health plans comprises benefit configuration, testing, claim adjudication and audit ensuring regulatory compliance and adherence to plan guidelines.

Netmark TPA Adjudication Services

Third Party administrators are a key part of the US economy and have pivotal roles in Commercial health Insurance, Commercial liability insurance and in Investment company Operations (401K etc.)

Netmark specializes in Health plan and TPA adjudication and processes several million claims each year with 99%+ accuracy levels. We help TPA’s offload the burden of maintaining a huge adjudication team. It is very challenging to predict the cadence of the flow of claims in any business, Netmark helps TPAs not get overwhelmed or underwhelmed with high volumes or have staff waiting on claims to be presented. With over 10 years+ experience in claims processing we provide a very flexible work staff experienced in most of the top tier TPA adjudicating systems like Javelina, VBA, Plexis, WEX etc.

TPA Service in USA

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Frequently Asked Questions

Health claim adjudication is the process of reviewing claims for coverage, accuracy, and completeness. We follow a robust process for claim adjudication, which includes benefit configuration, testing, health claim adjudication, and audit.

TPA Adjudication involves following the rules set out in the commercial or Muni’s benefit plan design, as well as any applicable regulations. Netmark Business Services has a team of professionals who are familiar with the latest rules and regulations, ensuring regulatory compliance and adherence to plan guidelines.

Paying a health care provider for a consult or service is governed by several intricate rules such as network status, charge master contracts, and PBM contracts. For a corporation to do all this by itself will need a huge team of experts working full-time. They may still not be able to enjoy the benefits of multiple contracts that could lower costs as can be brought to the table by a TPA. Netmark works with several TPA around the country and brings the expertise and wisdom of the experts with it.

TPA Adjudication can be used to review a variety of claims, including medical, pharmaceutical, dental, ophthalmic, and behavioral health. Netmark Business Services can adjudicate all the above-mentioned claims.