V3 Repricing Engine: Fueled by Big Data to Ensure Fair, Market-Supported Reimbursements

PHOENIX, Ariz. (Sept. 14, 2020) – To accelerate fair and accurate claim repricing and ensure market-supported reimbursements, Vālenz™ has introduced the V3 Repricing Engine. Fueled by the volume, variety and velocity of data within the Valenz ecosystem, V3 supports strategic decision-making and creates value for the payer, the provider and the patient.

The V3 Repricing Engine can identify patterns and pinpoint high-performing providers with optimal cost structures, along with delivering greater efficiency and reduced turnaround times for processing and payments. Ultimately, it ensures savings on professional claims, which account for up to 85% of claim volume for self-funded insurers.

Aggregating years of robust claims data with industry-leading sources, the V3 Repricing Engine uses the proprietary, data-rich VMSSM Repricing Methodology to determine fair, defensible claim reimbursements. Its detailed analysis goes further to identify potential program pain points and opportunities for additional savings. For integrity and timeliness, VMSSM continuously scrubs and adjusts the data as needed to ensure a fair market price for all services rendered, while identifying potential fraud, waste and abuse.

“As we continue to identify solutions that control costs while serving the member and helping the employer, the V3 Repricing Engine is one more way we fulfill our promise of better, smarter, faster healthcare,” said Rob Gelb, Chief Executive Officer of Valenz. “The proprietary algorithms of our VMSSM Repricing Methodology provide actionable insights to support a consistent and substantiated reimbursement model, reducing friction among the payer, provider and patient.”

Curating from multiple data sets to offer up-to-date, regionally specific reimbursement recommendations, the V3 Repricing Engine is fueled by the three Vs of big data:

  • Volume: Years of historical paid claims data
  • Variety: Numerous geographical, medical and claim data elements
  • Velocity: Up-to-date information using real-time insight

“While the V3 Repricing Engine applies to all medical claims, it maximizes discounts for high-volume, low-dollar claims – an overlooked segment in the market to increase value for self-funded plans,” said Amy Gasbarro, Chief Operating Officer of Valenz. “This approach to repricing reduces the cost of healthcare for all parties involved.”

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

The Vālenz Payment Solution: Electronic Solutions for Timely and Efficient Claim Payments

PHOENIX, Ariz. (May 12, 2020) – In response to surging demand for electronic claim payments, leaders at Vālenz™ today announced the rollout of the Valenz payment solution. This development further expands the Valenz ecosystem to include fully automated solutions for electronic provider payments.

With the Valenz payment solution, payers and third-party administrators can automate and streamline payment processes for health, dental and workers’ compensation claims – eliminating the delays of manual payment processes and ensuring payments arrive on time. While the need for electronic payment solutions was already on the rise, the widespread shift to working from home has led to rapid acceleration of the Valenz payment solution, now being released ahead of its original late 2020 schedule.

“COVID-19 has presented many unforeseen operational challenges, especially for organizations with manual processes that raise barriers to conducting business as usual right now,” said Jordan Hersh, Vice President, Enterprise Solutions at Valenz, adding that Valenz is dedicated to meeting client needs even as those needs change day by day during the pandemic response. “The current situation called for us to provide electronic payment solutions as soon as possible for our clients, and we were very happy to make that happen.”

The Valenz payment solution enables clients to send provider payments on time and according to their providers’ own preferences, including virtual card payments. Timely, accurate payments are an important part of maintaining healthy relationships with hospitals and providers, and electronic claim payments eliminate manual steps to streamline operations and reduce expenses. With the Valenz payment solution, all payments are processed on a single system of record, regardless of payment type. And, because security is paramount, the platform is HIPAA and NACHA compliant, and it meets all federal and state requirements for electronic payments.

“Simplified payment processes, operational efficiency and clearer communications benefit all health plan partners, especially while working through significant changes in the work environment,” said Rob Gelb, Valenz Chief Executive Offer. “The Valenz payment solution is an important part of our promise to support our clients in achieving smarter, better, faster healthcare.”

Learn more here.

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

Vālenz Embeds Planwatch into Claim Workflow for Actionable Data

STOW, Ohio (November 1, 2019) – With healthcare spending projected to rise more than 5 percent each year and three-quarters of that spending tied to chronic disease, the need to better manage medical costs has never been greater. To provide self-insured employers, third party administrators, health plans and others with data that drive smarter, more cost-effective decisions, ProServe Health Informatics is pleased to be part of the Vālenz ecosystem.

Through Planwatch, its flagship product, ProServe Health adds deep, integrated financial analytics to fuel Vālenz Claim, a core component of the Valenz ecosystem. By aggregating and mining in-network and out-of-network medical claim data, Planwatch provides intuitive and detailed financial reporting, as well as plan modeling to help direct and systemically lower healthcare spend.

Including Planwatch in the Valenz ecosystem enables more proactive decision-making and a greater opportunity to disrupt the cost curve. “We are leveraging interoperability with partners like ProServe Health to provide actionable business intelligence that helps clients reduce plan costs, not just in the short term but on a more sustained basis,” said Rob Gelb, Chief Revenue Officer at Valenz. “For robust visibility into in-network and out-of-network medical claims savings, Planwatch supports our promise to engage early and often for smarter, better, faster healthcare.”

Georgeann Seuffert, Vice President of Sales at Planwatch, agrees. “We are pleased to take our existing relationship with Valenz to the next level because we share a common goal to provide solutions that substantially influence better health outcomes and reduce total cost of care,” she said. “It is very refreshing to partner with an organization that wants to invest back into their clients. The Valenz commitment to Planwatch as a value-added service speaks volumes about their dedication to healthcare delivery and savings.”

About ProServe Health Informatics

Planwatch is a product of ProServe Health Informatics. It was developed in 2005 by company co-founders who recognized both the need and the solution for an economical, user-friendly, high level data analysis, web-based reporting, benchmarking, disclosure and plan modeling tool for the Payor community. Planwatch examines historical, current, and future health plan dimensions, integrates, combines and compares pharmacy and medical costs, identifies cost drivers and performance metrics, and provides tested solutions to minimize plan expenditures. Query and produce ad-hoc reports by cost, coverage areas, procedure codes, POS, geographical locations, network performance, prescriptions, and over 150 query fields by employer, participant or payor block of business. For more information about Planwatch, visit their website: www.plan-watch.com or contact Georgeann Seuffert, Vice President of Sales at (888) 275-2242 or gseuffert@proservehealth.com.

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Serving self-insured employers, third-party claim administrators, brokers and benefit consultants, trust and labor organizations, stop-loss carriers, integrated healthcare delivery networks, and health/dental plan payers, Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available online at valenzhealth.com. Valenz is backed by Great Point Partners. For more information about Valenz, visit www.valenzhealth.com or call (866) 762-4455.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading health care investment firm, currently with approximately $1.8 billion of equity capital currently under management and 28 professionals, investing in the United States, Canada, and Western Europe. GPP is currently making new private equity investments from GPP III. Great Point manages capital in private (GPP I, $156 million and GPP II, $215 million of committed capital, and GPP III which has $306 million in committed capital) and public (BioMedical Value Fund family, approximately $1.1 billion) equity funds. Great Point Partners has provided growth equity, growth recapitalization, and management buyout financing to more than 100 growing health care companies. The private equity funds invest across all sectors of the health care industry with particular emphasis on biopharmaceutical services and supplies, outsourcing and alternate site care, pharmaceutical infrastructure and information technology enabled businesses. The firm pursues a proactive and proprietary approach to sourcing investments and tuck-in acquisitions for its portfolio companies. Reach Great Point at (203) 971-3300 or www.gppfunds.com.