Proactively Validate Care with Clinical Bill Review
Unlock Savings by Uncovering What Traditional Bill Review Misses
Eliminate Errors from Medical Claims and Bills
Your Comprehensive Review for Compliance and Cost Savings
Medical billing is complex, and even minor errors can lead to major costs. Unfortunately, poor documentation, duplicate charges, and incorrect and missing codes are ubiquitous in today’s claims, wasting significant time and money for all involved.
The solution: Valenz Clinical Bill Review.
By leveraging advanced AI and experienced clinical and coding teams, Vālenz Health® verifies medical necessity, provider credentials, and contract alignment before payment is ever made—ensuring every claim is accurate, compliant, and cost-effective to deliver savings that exceed expectations.
Reviewing and Verifying Charges Before Payment
Reduce Your Spend with Data-Driven Clinical Bill Review
Most billing errors stem from incorrect procedure or diagnosis codes, triggering claims denials, payment issues, and rising administrative costs—affecting patients, medical practices, and plan managers alike.
Through our Clinical Bill Review solution, Valenz identifies those errors early on, ensuring appropriate charges are accounted for on every claim.
Complex Clinical Claim Review
Ensure professional review of complex, high-dollar, or unusual claims to assess appropriateness of care, determine treatment justification, prevent excessive payments for unnecessary care, and more.
Ensure in-depth clinical evaluation
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Assess medical necessity and appropriateness
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Validate high-severity coding
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Reduce risk of overpayment
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Support fair, evidence-based payment
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Ensure accurate payment
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Confirm coding compliance
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Detect upcoding or errors
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Support cost containment
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Enhance audit and regulatory compliance
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Diagnostic-Related Groups (DRG) Validation and Review
Verify that a hospital’s billed diagnostic-related groups (DRG) matches the documented medical care, identify cases where expensive DRG is used incorrectly, and control healthcare spending through expert claim review and validation.
Fraud, Waste, and Abuse (FWA) Review
Reduce claim leakage with trained experts and data analysis tools that catch billing inconsistencies stemming from possible fraud, waste, and abuse (FWA).
Identify irregular billing
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Prevent wasteful spending
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Protect financial integrity
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Promote compliance and accountability
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Review charges item by item
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Validate medical necessity
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Check for coding and pricing errors
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Ensure contractual compliance
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Reduce overpayment risk
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Line-Item Bill Review
Ensure claim accuracy and medical necessity of services with detailed, line-item review of hospital and provider bills.
Post-Payment Recovery
Uncover billing errors, duplicate payments, and incorrect reimbursements in previously paid claims to recover funds and lower your overall healthcare costs.
Identify overpayments after reimbursement
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Recover excess funds
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Support ongoing cost containment
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Enhance data-driven auditing
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Promote accountability and compliance
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Reduce risk of balance billing
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Enhance provider networks
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Ensure fair reimbursements
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Improve quality while decreasing costs
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Access full-service claim management
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In- and Out-of-Network Negotiation
Negotiate billing and costs with facilities and providers, both in-network (INN) and out-of-network (OON), for more effective cost containment.
Onsite Audit
Ensure regulatory compliance and avoid costly fines through onsite review of billing and practices, conducted by a team of certified auditors.
All Your Health Insurance Solutions on One Platform
Explore the Vālenz Health® Integrated Platform for Simplified Healthcare
Seamlessly unite member experience, payment integrity, provider quality, and plan performance with our integrated platform. Discover how we optimize the utilization of high-value healthcare across the entire member journey.
Greater Savings, Efficiency, and Experiences
Valenz Clinical Bill Review Case Studies
$900k+ Savings and Rapid Care with Early Engagement Strategies
Through pre-negotiation, part of the comprehensive Clinical Bill Review solution, Valenz collaborated across broker, carrier, employer group, provider and third-party administrator (TPA) to achieve significant savings and expeditious care for a member requiring complex surgery.
Nearly $865k in Overpayments Identified and Recovered
With our Post-Payment Recovery solution, Valenz helped a previously restricted stop loss organization identify more than $1 million in discrepant charges on two high-dollar claims, recovering nearly $850,000 after these claims were paid.
Uncovering Errors and Overpayments on High-Cost Claims
A large commercial health insurance carrier retained Valenz to drive additional savings by uncovering errors and overpayments across high-dollar, in-network claims.
Ready to Simplify Self-Insurance?
Your Journey Starts Here
Connect with a Valenz team member to explore the difference our solutions can make for you.