Netmark Payer Services are experts adjudicating health plan and third-party administrator claims. We understand 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 medical claims examiners are experts using FACETS, QICLINK, QNXT, DIAMOND, DST, AMISYS and most other commercial claims administration software platforms. Through secure, remote connectivity, Netmark uses our client’s claims administration software for back-office adjudication efficiency, lower cost and seamless operation.
NETMARK’S HEALTHCARE CLAIMS ADJUDICATION SERVICES INCLUDE:
- Rules-based editing
- Duplicate claims identification
- Eligibility checking
- Rejected claims recommendation
- Advanced claims editing
- Fraudulent claims detection
- Benefits determination and coordination
- Raw claims data correctness verification
- Remittance processing
- Appeals processing
CLAIM TYPES NETMARK ADJUDICATES:
- CMS 1500
- Dental claims
- Vision claims
- HRA claims
- HSA claims
- Critical illness claims
- Limited-benefit plan claims
- Short-term disability claims
- UB92
- UB04
- Pends/Rejected/Correspondence
- FSA claims
- Business travel accident claims
- Hospital indemnity claims
- Minimum value plan claims
- Student study abroad claims