The netwerkes.com Claim Management System is a real-time, state of the art Claim Management System built for the internet from the ground up using cutting-edge technology. The Claim Management System provides you with a comprehensive set of tools that allow you to manage the complete reimbursement cycle of your Dental, Professional, and Hospital claims.

Benefits of the Netwerkes.com Claim Management System:
 
  • Platform free architecture easily interfacing with your practice management system.
  • All Payer solution.
  • Extensive real-time validation ensures higher first past rate and faster payment.
  • Intuitive interface allowing for online correction of errors, rejections, zero paid claims, etc.
  • All Payer reports and remittance posted back to your claims. No more having to look through reports to find out the disposition of your claims.
  • Extensive claims and remittance reporting capabilities produced in the Adobe Acrobat format so you can print or download to your PC.
  • Secondary claims created intelligently from your remittance files with the click of a mouse.
  • Create rules to enhance or correct your practice management system.


Below you will find a complete description of all the services that are included in the Claim Management System at no extra charge (unless otherwise noted). For more information or if you wish to sign up for the Claim Management System please email our Sales and Marketing Department by clicking here or call our Customer Service center at (262) 523-3600.
 
Claim Validation Engine
    Netwerkes.com proprietary Claim Validation Engine contains the following edits;
    Medicare Validation
    • Common St Anthony Edits
• CCI
• LMRP
• NCD
• APC (additional fee required)
• OCE (requires the purchase of an OCE license)
   
HIPAA Validation
      Validation to ensure your claim is HIPAA compliant.
   
Payer Specific Validation
      Payer specific edits for most major Payers. Examples of these are insured ID checks, group number validation, is a provider number required in box 33 (professional) or box 51 (hospital), etc, etc.
   
Provider Validation
      Custom edits for your organization. Does your organization audit bills over 10,000? Do you need to flag a certain Payer if the type of bill equals 831? We build these edits for you so you can review these claims prior to being sent to the Payer.
 
Payer Rules System
    The Payer Rules System provides a powerful tool you can use to enhance your current practice management system. Its primary use is to help you fill in information on your claims that your current system cannot or which your current system is filling in incorrectly. The information to be filled in can be from a default value you specify or moved from another field on your claim. It can also be filled in conditionally based on whether data is present in another field and, if the data is present does it equal a specific value. Click here to learn more about the Payer Rules System.
 
Claim Reporting
    Our Claim Reporting system allows you to create ad-hoc reports on your claims data using a wide variety of parameters. Want to know how many claims were accepted by Medicare for the month of May? The Claim Reporting system will allow you to retrieve this data in a variety of comprehensive reports. These reports are created in the Adobe Acrobat format for easy viewing and downloading.
 
Electronic COB Claims
    Netwerkes.com allows you to send secondary claims electronically to a wide variety of Payers. See our Payer List for more information.
 
Mailed Claims System (additional $0.33 added to your transaction fee)
    Claims that cannot be sent electronically can be mailed for you. The addresses on your claims are run through address verification software to confirm they are correct. If the address is invalid, we will post this information back to your claim and allow you to query the postal database to find the correct one. This address verification helps improve collections by eliminating returned mail.
 
ERA (Electronic Remittance Advice)
    Netwerkes.com will pick up your electronic remittance files from a wide variety of carriers. These files can be downloaded and posted to your practice management system for auto-adjudication of accounts. All remittance advice is posted to your claims data allowing you to create reports in the Adobe Acrobat format. You may also create secondary claims from the remittance advice (see the Secondary Claims System for more info).

In addition to the posting of remittance, Netwerkes.com has created a robust reporting tool for querying your remittance advice. Want to know how many zero pays you had in your last Medicare payment? Do you need to find all remittance that contained a certain denial code? Our remittance query system will let you do this and a lot more. You can even adjust the corresponding claims and release them again for payment.
 
Secondary Claims System (additional $0.20 charge added on to your mailed claim fee)
    Generate and send secondary claims from your electronic remittance files. No more having to print EOB’s and mail them yourself. Claims are generated based on the status code of the remittance advice so only claims that have not been forwarded to the secondary carrier will be created.
 
Reverse Print Image Creation
    Use the Claims Reporting System to create a reverse print image of your claims data for uploading into other systems.
 
 
The netwerkes.com Claim Status Inquiry System allows you to send both real-time and batch Claim Status Inquiries to a variety of Payers. The Claim Status Inquiry System is integrated with theClaim Management System allowing you to perform Claim Status Inquiries on existing claims with the click of a mouse. The integration of the Claim Management System and Claim Status Inquiry System gives you a powerful tool to find out why your claims were accepted by the Payer but no remittance was received.

In addition to single claim status inquries, Netwerkes.com has become the first in the industry to release the Claim Status Inquiry Scheduler. This powerful tool lets you schedule inquiries to be run at certain intervals. Do you have a
  Payer with timely filing limits? Merely have the Claim Status Inquiry Scheduler automatically send inquiries on claims that were sent to the Payer more than 30 days ago (you can set this to any number) that do not have remittance advice associated with them. These schedules can be run daily, weekly, bi-weekly, or monthly. No more losing revenue due to timely filing provisions.

For more information or if you wish to sign up for the Claim Status Inquiry System please email our Sales and Marketing Department by clicking here or call our Customer Service center at (262) 523-3600.
 
 
 
The netwerkes.com Eligibility Verification System allows you to send both real-time and batch Eligibility Inquiries to a variety of Payers. These inquiries can be in the form of single lookups by your registration department or batch files we receive from your organization. The response to these batch file uploads can be downloaded from netwerkes.com for auto-posting to your practice management system.

The Eligibility Verification System is a cost effective alternative to more expensive Eligibity Services because we store your inquiries and
  inform you if there is an existing inquiry on our system for a particular recipient prior to sending a new inquiry. This checking for existing inquiries is not just performed for a particular office but, on an enterprise level meaning if one of your clinics performed an inquiry, your hospital admissions staff will have the opportunity to view the existing lookup without generating another one. In addition, because the Eligibility Verification System stores your inquiries you will have them available to your organization for years to come ensuring you will always have proof that coverage was verified by the Payer.

In addition to the stand-alone service, the Eligibility Verification System is also integrated with Claim Management System to check for coverage on claims you upload to the website. If no coverage is found we post this information to the claim itself and give you the opportunity to send another inquiry. Best of all, this claim validation is included with the transaction cost of the Claim Management System System so there is no additional charge for Eligibility Inquiries performed on your claim uploads.

For more information or if you wish to sign up for the Eligibility Verification System please email our Sales and Marketing Department by clicking here or call our Customer Service center at (262) 523-3600.
 
 
The netwerkes.com Billing Statement System allows you upload a statement file for mailing by netwerkes.com. The addresses on your statements are run through address verification software to confirm they are correct. If an address is invalid, we will post this information back to your statement and allow you to query the postal database to find the correct one. This address verification helps improve collections by eliminating returned mail.
  For more information or if you wish to sign up for the Billing Statement System please email our Sales and Marketing Department by clicking here or call our Customer Service center at (262) 523-3600.
 
 
The netwerkes.com Referral System allows you to send referral information online to select Payers. The Payer reviews the referral information and posts the disposition back to your request, eliminating the need to mail or fax this information and increasing efficiencies for all parties involved.

For more information or if you wish to sign up for the Referral System please email our Sales and Marketing Department by clicking here or call our Customer Service center at (262) 523-3600.
 
 
User Maintenance
 Allows administrators to add users, reset passwords, and deactivate users eliminating the need to call netwerkes.com to have these functions performed. Access to this utility is restricted to persons designated as administrators by the contracting party.

Inter-Site Messaging System
  Allows you to send and receive messages via our website interface. These messages are encrypted (via SSL) so you can send sensitive data without having to worry about being HIPAA compliant.
 
Task Tracking System
  Did you call us with a question or send an inquiry to us via the Inter-Site Messaging System? The Task Tracking System allows you to monitor the status of your question until resolution. No more waiting to hear back from a customer service representative. With the Task Tracking System you can check to see if we are waiting to hear from the Payer, if the task is in technical support, or you can check to see if we have answered your inquiry. You can even add additional comments to these Tasks that will be seen by the current owner.
 
User Claim Views
  Claim views allow administrators to restrict claim access for specific users by Payer, Facility Name, Tax ID, etc. This functionality is used in organizations where individuals only work certain claims (Medicaid for example). Efficiency is increased because the user is only able to view/work claims they are responsible for.


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