Fueled by analytics that blend payment, cost and charge-based data
Valenz Open Solution integrates deep analytical insights with member-centric services to find balance in the cost-quality equation. This non-network reimbursement strategy focuses on active collaboration between all parties to ensure transparency and reduce friction among the payer, provider and patient.
Valenz Open Solution also leverages the VMS® Repricing Methodology to deliver fair, defensible, consistent claims pricing. With personalized care navigation as the point of entry, fair market pricing as the goal, and a high-value provider network as a future outcome, this option improves savings, access and quality while also fostering positive, equitable relationships with providers.
Streamline the path to lower costs and healthier lives
By engaging early and often for smarter, better, faster healthcare, Valenz Open Solution delivers many advantages:
- Cost Control: Fair, acceptable market pricing based on geography
- Defendable Reimbursement Methodology: Reliable, algorithmic decision-making powered by VMS®, complete with support for appeals*
- Data-Driven Insights: Access to quality metrics and performance outcomes for increased provider accountability
- Pre-Service Negotiations: Agreements with providers and facilities to drive high-value network development, steerage and utilization
- Contracting Support: Valenz contracting experts support the plan and members through ongoing expansion and development of advantageous agreements with providers and facilities, driving high-value network development, direction of care and high-quality provider utilization
- Centralized Care Coordination: Our NaVcare navigators serve as the central point of contact for members, providers, payers and administrators
- Seamless Integration: Extend the power of the Valenz ecosystem to continuously drive cost and quality improvement, including quality and outcomes metrics for greater provider accountability.
- Also includes out-of-network solutions to replace wrap networks, full-service claim management, and a member portal with provider quality and cost data
* Valenz provides support and additional resources for appeal resolution and to defend employees against balance billing and attempts at collection.