Secured Savings with Full Claim Review

With payment errors or overpayments expected to cost up to $560 billion, or 7-10% of healthcare spending in 2026, payers need solutions that maximize savings on every claim, regardless of type or size. That’s why Vālenz® Health through its suite of Validation, Integrity and Accuracy (VIA) Solutions offers full claim review.

Designed to eliminate erroneous, questionable billing charges and unnecessary charges associated with fraud, waste and abuse, Valenz ensures appropriate, defensible and transparent payments secured by signed provider agreements. In fact, our customers experience signoff success rates averaging 70%, with less than 5% of reviews overturned by providers.

Full Claim Review Services

Line-item bill review

Clinical review by a nurse or a physician

Improper, upcoding and unbundling review

DRG coding and clinical validation review

Qualified Payment Amount (QPA) review and analysis

Usual and customary charge review

Provider negotiation with signoff for network and out-of-network claims

Pre and Post Payment Reviews

Customer Resources

Industry-Recognized Solution with Secured-Savings

Conducted by experts and supported by AI, our full claim review averages an additional 35% savings over contracted network discounts — complete with a signed contract, agreed upon and authorized by the provider.

Designed to eliminate erroneous, questionable billing charges and unnecessary charges associated with fraud, waste and abuse, Valenz ensures appropriate, defensible and transparent payments secured by signed provider agreements. In fact, our customers experience signoff success rates averaging 70%, with less than 5% of reviews overturned by providers.

Drive Additional Savings on High-Dollar Claims

With VMS® Market Sensitive Repricing, operational cost intelligence, and a foundation of expertly curated data sets and advanced analytics, Valenz Specialty Solutions unlock additional savings for very high-dollar, usually low-utilization claims, including:

69%

average savings

Ambulatory Surgery Centers

50 - 80%

average savings

Air Ambulance

49%

average savings

Substance Abuse Treatment

25%

average savings

Renal Dialysis

25%

average savings

Specialty Medications

Reduce Costs and Secure Long-Term Savings with Full Claim Review

We consistently uncover additional areas of savings by delivering transparency through collaboration.

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Experience the Platform to Simplify Healthcare

In addition to full claim review, Valenz simplifies the complexity of self-insurance by offering an end-to-end platform that manages the cost and quality of care for employers and their members. Our solutions drive value across clinical and member advocacy, network development, the validation, integrity and accuracy (VIA) of claims, and risk affinity solutions.

Case Studies

Children’s Hospital with BUCAH

See how we found opportunities for 13.86% in additional savings above BUCAH PPO discounts, and secured provider signoff to deliver our client $129,648 in net savings.

High-Dollar Claims

Learn how our detailed line-by-line bill review delivered $93,798 in net savings, secured provider signoff and ensured no balance billing to the patient.

Medical Records Review 

See how our credentialed reviewers utilized our fact-based model and strong working relationship with providers to secure signoff on savings 23.8% above the PPO discount in less than two hours.