Control Costs and Reduce Friction with Out-of-Network Repricing
Redefine Savings for High-Cost, Out-of-Network Claims
Streamlining Claims Processing for Better Results
Trust Vālenz Health® to Decrease Out-of-Network Plan Spend
It’s no secret that out-of-network spend poses a significant challenge to self-funded group health plans—driving up costs, creating billing surprises, and straining provider relationships.
Make things simple with Valenz Out-of-Network (OON) Repricing.
Improve total health spend for employers and offer greater flexibility for members seeking high-quality care with the proprietary Vālenz Health® claim pricing methodology—Valenz Market-Sensitive (VMS®) repricing.
We reduce provider friction and lower cost using features traditional solutions often lack —delivering better cost-containment than other leading industry players.
Differentiator |
Vālenz Health® |
Industry |
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Multiple data sets to determine fair and reasonable reimbursement |
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"Friendly" providers, tracked to support direction of care |
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Alignment with member, payer, provider, and plan to balance cost, quality, and utilization |
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Support for any claim with repricing methodology regardless of network design |
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Guaranteed savings on all claims billed under $5,000 |
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Guaranteed savings, regardless of billed amount, for ambulatory surgical center, behavioral health, mental health, and substance abuse claims |
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QPA support and management in CMS portal |
Maximizing Value and Efficiency for Health Plans
Unlock Higher Savings with
Data-Driven Cost Containment
Leveraging the VMS claim repricing methodology, we ensure fair, defensible, market-supported reimbursements when members receive care beyond contracted, in-network facilities and providers.
With operational cost intelligence and expertly curated data sets informed by advanced analytics, our Out-of-Network Repricing solution unlocks significant savings for high-cost, low-utilization claims.
Our VMS repricing methodology aggregates years of robust claims data from provider network cases, with industry-leading sources of payment-, cost-, and charge-based data sets, as well as biometrics and clinical data.
The result: Reimbursement recommendations that are fair, defensible, transparent, and consistent for everyone.
Valenz Health has attained a HITRUST i1 certification for its Claims system.
HITRUST certification validates Valenz is operating leading security practices to protect sensitive information.
Improved total health spend for employers
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Greater flexibility for members to seek high-quality care
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Reduction in provider friction with appeals management and resolution
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Guaranteed repricing for ambulatory surgical center, behavioral health, mental health, and substance abuse claims
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Additional Features to Support You
Cost-Containment Strategies for High-Dollar Claims
Our Out-of-Network Repricing supports you with additional features and opportunities to ensure your success.
Air Ambulance Repricing
Lower the cost of OON air transport and meet No Surprises Act (NSA) compliance with our Air Ambulance Repricing methodology.
50%–80% Average Savings
Applied Behavior Analysis (ABA) Repricing
Minimize OON spend on applied behavior analysis with predictable vendor fees delivered by an efficient, easily implemented repricing program.
85% Average Savings
Renal Dialysis Repricing
Reduce the financial risk of high-cost dialysis services with a proactive approach to claim management that protects both payer and patient.
70% Average Savings
Guaranteed Payment
Minimize the risk of balance billing, member disruption, and provider friction for the largest percentage of your claims with our assured payment options.
For claims less than $5,000, Valenz assumes financial responsibility for any amount owed to the provider above the original VMS repriced allowable. For claims greater than $5,000, VMS repricing methodology maximizes savings.
For ambulatory surgical centers, behavioral health, and mental health services, all claim savings are guaranteed, regardless of the billed amount.
96% of Claims Automatically Adjudicated
Non-Contracted Networks
Ensure employees are directed to high-quality providers while lowering costs, improving outcomes, and enhancing experiences with a non-contracted reimbursement approach, supported by care coordination and navigation.
Let Valenz assume the risk for claims at and below tailored levels, and we'll maximize savings on any remaining claims with our market-sensitive repricing methodology.
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.
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.