Delivering total insight to ensure appropriate payment

With the continued challenges of medical billing accuracy and transparency, self-funded employers and the self-insured community need confidence they are paying medical claims appropriately. Vālenz ProteKHt ensures appropriate and accurate charges are accounted for on every line of every claim, correcting unnecessary, unrelated, irregular or inappropriate medical billing while enhancing the claim management process.

Industry Recognized Solution for Secured Savings

Valenz ProteKHt frees health plans from relying solely on contracted network discounts, delivering savings 10-30% above the PPO allowable with a signed contract, agreed upon and authorized by the provider.

With success rates averaging 70%, Valenz ProteKHt is the industry’s recognized comprehensive and complete bill review solution. We ensure appropriate, defensible and transparent payments that are secured by signed provider agreements.

Eliminating erroneous, fraudulent and medically unnecessary charges allows health plan costs to remain focused on improving outcomes and helping members lead strong, vigorous and healthy lives.

Bill Review Sign Off

Secured agreements, high capture rates and deep savings

Detailed line-by-line bill reviews with provider sign off ensures that incorrectly billed charges and clinically inappropriate services are not reimbursed.  By consistently securing provider sign off, Valenz ProteKHt eliminates provider appeals and balance billing while delivering significant savings for Valenz customers.

Bill Review

Clear, defensible, transparent and plan-specific reviews

Should providers be unwilling to agree to write off discrepancies that don’t meet industry standard coding and care guidelines, Valenz ProteKHt offers payers detailed bill reviews and full appeal support. We manage appeal processes with providers directly, and reduce friction by ensuring accuracy, consistency and transparency.

Customer Resources

Expert Peer Review

Our credentialed reviewers offer unparalleled expertise in handling claims and investigating charges. Through a professional team of certified coders, registered nurses, board-certified physicians, licensed pharmacists and licensed social workers, we consistently deliver defensible peer review for any type of claim or charge.

Data-Driven Ecosystem

As part of the Valenz ecosystem, data is the fuel behind our engine and allows us to bring exceptional analytical efficiency when examining prices, coding and care to ensure appropriate payment. Through a fact-based, data-driven model and approach, we engage early and often to deliver optimal investigation results and fast turnarounds – within 24 hours of receiving the itemized bill.

Personalized Solutions

We develop personalized solutions that meet the unique needs of our customers, allowing them to remain agile as they navigate a continually evolving environment in claims. Our active partnerships are built on personal attention and the commitment to “Customer Love” – connecting the dots to draw and manage the big picture for superior service.

Savings Revealed

  • Medical Necessity
  • Unbundling
  • Duplicate Charges
  • Pricing Inconsistencies
  • Medically Unlikely/Impossible
  • Line Charge Verification
  • Code Edits
  • Experimental and Investigational
  • FDA Approved
  • Level of Care