A self-funded plan sought assistance in repricing and paying outstanding claims for a pediatric ABA case. Using its Clinical Bill Review solution, the Valenz payment integrity team delivered an approximate 66% reduction on initial billed charges of more than $5 million for a total potential savings of nearly $4 million for the plan.

By implementing a combination of Valenz Bluebook and Valenz Bluebook Rx solutions, a longtime client maximized their savings while curbing medical and pharmacy spend through cost and quality navigation tools — delivering nearly $1.2 million in total savings for a 2.8:1 combined program ROI in just two years.

Using the Valenz Bluebook Rx solution, a benefit plan guided members toward smarter medication choices to significantly reduce overall spend, achieving $270,000 in total savings and a 2.4:1 return on investment in just nine months.

By deploying the Valenz Bluebook Rx solution, a client facing rising pharmaceutical spend was able to direct members to lower-cost, comparable medication alternatives to achieve a total savings of $13.5 million over five years.

A large healthcare plan payer partnered with Valenz to conduct a comprehensive review of more than 626,000 medical claims incurred over six months to capture potential savings from billing inaccuracies, coding errors, and clinical discrepancies. Using its Clean Claim Verification solution, the Valenz team identified potential savings of $112.6 million in initial billed charges, reduced to $43.4 million in allowed charges.

A regional health plan with approximately 130,000 covered lives recently partnered with Valenz to address a high-cost air ambulance claim. By leveraging the Air Ambulance solution, a feature of Valenz Out-of-Network Repricing, the team reduced the initial provider offer for a combined savings of $20,000.

A medical provider network company recently partnered with Valenz to minimize ever-rising costs from member care, employing the Valenz Clinical Bill Review solution to identify and resolve billing errors and inconsistencies — resulting in more than $460,000 saved on an inpatient drug claim.

A TPA representing a 125-life group approached Valenz for a stop loss quote that would reduce expenses for the plan payer. With our data-driven underwriting, Valenz designed a policy that would save the organization $20,000 a year in premiums by incorporating additional cost-containment solutions.

With healthcare costs soaring, an employer in the Southeast needed a solution to empower employees to make smarter, more cost-effective care decisions — supporting cost containment and strong, vigorous, healthy lives for all. The employer partnered with Valenz to implement a shared savings model and engagement strategy that drove higher utilization, better care outcomes, and $239,000 in total savings.

A large insurance and investment company insuring nearly three million union members and their dependents partnered with Valenz to conduct a line-item bill review on a high-cost claim and to engage in provider collaboration, resulting in 57% in savings above the PPO allowable.

To help rein in spending and maintain a workplace culture that treats everyone like family, Alex Lee focused on shared accountability: incentivizing employees to choose high-value care and save money for everyone. By building a trusted partnership with Valenz Bluebook, Alex Lee empowered employees to shop for high-value healthcare, resulting in a 146% increase in savings.

Through strategic pre-negotiation, Valenz collaborated across broker, carrier, employer group, provider, and third-party administrator (TPA) to achieve expeditious care and savings of more than $900,000 for a member requiring complex surgery.

By integrating the full continuum of self-funding solutions on the Valenz platform, a three-school consortium in Missouri transformed its healthcare model to reduce actual health spending while maintaining superior clinical quality and member experience — ultimately achieving $4.3 million in first-year savings.

Discover how Valenz Clinical Bill Review solution created second-pass additional savings of $120 million ($40,000 average per claim) by supplementing the payment integrity program of a large multi-state health plan.