Claim Adjudication
Netmark Payer Services understands the implications of timely, accurate claims adjudication and provides a solution that is efficient, scalable and affordable for claims that do not auto-adjudicate. Netmark’s claims adjudication and examination teams are experts with FACETS, QICLINK, QNXT, DIAMOND, DST, AMISYS, and most other claims management software platforms.
Member Fulfillment
Netmark specializes in creating verified mailing lists and preparing the right membership welcome packet for new beneficiaries. Most insurance companies mail a welcome packet to their new members once members have been enrolled and verified. Packets include benefit details, formularies, health, and wellness information.
Member Enrollment
Netmark Payer Services provides valuable call center services for the fall Medicare, Commercial and ACA sign up period. Netmark can help your health plan shine when existing and new Medicare, Commercial or ACA participants call to compare benefits, pricing and formularies while removing the staffing pressure from the huge spike in in-bound calls.
Co-ordination of Benefits
Coordination of Benefits (COBs) can be a time consuming, costly and frustrating process for a health plan, but Netmark’s COB workflow process removes the hassle and expedites accurate claims adjudication. Netmark Payer Services COB process determines whether Medicare or a supplemental insurance company pays first.
Pre Adjudication Services
Netmark Payer Services deploys proprietary workflow, OCR and human oversight to non-conforming, manual and handwritten claims including CMS 1500, UB-04, dental and vision. The claims are examined, and any missing information is populated. At that point, the claim forms can then be shared with the providers for their records.
Utilization Management
The Netmark Payer Services Utilization Management program uses regular feedback and the authority of a medical director to simultaneously maximize health care and optimize medical costs. Netmark Payer Services Utilization Management offers a Utilization Management program that focuses on prospective Utilization Management.
About Netmark
Netmark Business Services started in 2010 as a back office for the Healthcare Industry. Netmark’s focus is on effective revenue management in the healthcare space, through efficient processes, productivity enhancements and deep domain expertise. With service offerings across the Provider and Payer domains, Netmark has expertise and experience spanning the entire life cycle of the claim, and the capability to leverage that experience to enhance specific process deliverables. Over the years, this experience and understanding of the claims has helped Netmark add value to our client’s operations. This has led to the creation of three divisions: Netmark Payer Services; Netmark Medical Records Review and Netmark Revenue Cycle Management.
NETMARK PAYER SERVICES
We are your qualified and committed partner for claims adjudication services.
We understand the entire life cycle of a claim with our payer and provider services experience.
We can affordably implement and quickly scale a claims adjudication team to process your appeals, resolve your co-ordination of benefits claims and adjudicate all your claims that did not auto-adjudicate.
We provide other payer services including utilization management, member fulfillment, member enrollment call center support and pre-adjudication services.
We work seamlessly as a partner for payers leveraging experienced adjudication teams that use QNXT, Facets, Amisys, DST, Qiclink, Diamond and other claims management software.
We are proud of our 97%+ error-free processing track record.
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Member Enrollment
Netmark Payer Services provides valuable call center services for the fall Medicare, Commercial and ACA sign up period. Netmark can help your health plan shine when existing and new Medicare, Commercial or ACA participants call to compare benefits, pricing and formularies while removing the staffing pressure from the huge spike in in-bound calls.
Utilization Management
The Netmark Payer Services Utilization Management program uses regular feedback and the authority of a medical director to simultaneously maximize health care and optimize medical costs.Netmark Payer Services Utilization Management offers a Utilization Management program that focuses on prospective Utilization Management.
Claim Adjudication
Netmark Payer Services understands the implications of timely, accurate claims adjudication and provides a solution that is efficient, scalable and affordable for claims that do not auto-adjudicate. Netmark’s claims adjudication and examination teams are experts with FACETS, QICLINK, QNXT, DIAMOND, DST, AMISYS, and most other claims management software platforms
Co-ordination of Benefits
Coordination of Benefits (COBs) can be a time consuming, costly and frustrating process for a health plan, but Netmark’s COB workflow process removes the hassle and expedites accurate claims adjudication.Netmark Payer Services COB process determines whether Medicare or a supplemental insurance company pays first.
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