Control Costs and Reduce Friction with Out-of-Network Repricing

Q: How does medical bill repricing help control out-of-network plan spend?

Repricing takes the surprise out of out-of-network costs. We use the Valenz Market-Sensitive (VMS®) methodology to look at years of real-world claims data and find a fair reimbursement rate. Instead of accepting a high bill, you get a defensible price that lowers your total health spend.

Q: What makes Valenz different from other reference-based pricing vendors?

Other vendors typically rely on reference-based repricing methodologies based on published Medicare rates. Our methodology goes beyond that to incorporate seven types of objective datasets for a more comprehensive, defensible approach to repricing out-of-network claims.

Q: Can out-of-network claims repricing help with expensive air ambulance bills?

Yes. Our out-of-network claims repricing includes a specific air ambulance repricing methodology to ensure compliance with the No Surprises Act. This helps you secure significant savings — often between 50% to 80% — on high-dollar transport claims. Read our case study to see the savings in action.

Q: Can we really guarantee savings on behavioral health claims?

Our programs are powered by data-driven technology that brings together cost and quality transparency, digital navigation tools, and personalized clinical support. With this technology, every member has the ability to make more informed healthcare decisions.

Q: Can we really guarantee savings on behavioral health claims?

Yes. Valenz offers guaranteed savings for behavioral health, substance abuse, and ambulatory surgical center (ACS) claims. Through specialized medical bill repricing, we can often cut costs for applied behavior analysis by 85%, protecting your plan from the financial risk of high-cost, long-term care.

Q: How do you handle provider pushback on medical bill repricing?

We focus on frictionless results. Because our recommendations are backed by expertly curated data, our provider appeal rate stays under 1%. If a provider has questions, our team steps in to handle the resolution directly, keeping your team out of billing disputes.

Redefine Savings for High-Cost, Out-of-Network Claims

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See Your Savings Potential

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 plan spend using features traditional solutions often lack — delivering better cost containment than other leading industry players.

Explore the Valenz Advantage

Differentiator	Vālenz Health®	Industry
Multiple datasets to determine fair and reasonable reimbursement
"Friendly" providers, tracked to support direction of care
Alignment with member, payer, provider, and plan to balance cost, quality, and utilization
Support for any claim with repricing methodology regardless of network design
Guaranteed savings on all claims billed under $5,000
Guaranteed savings, regardless of billed amount, for ambulatory surgical center, behavioral health, mental health, and substance abuse claims
QPA support and management in CMS portal

Multiple data sets to determine fair and reasonable reimbursement

Vālenz Health®

Industry

"Friendly" providers, tracked to support direction of care

Vālenz Health®

Industry

Alignment with member, payer, provider, and plan to balance cost, quality, and utilization

Vālenz Health®

Industry

Support for any claim with repricing methodology regardless of network design

Vālenz Health®

Industry

Guaranteed savings on all claims billed under $5,000

Vālenz Health®

Industry

Guaranteed savings, regardless of billed amount, for ambulatory surgical center, behavioral health, mental health, and substance abuse claims

Vālenz Health®

Industry

QPA support and management in CMS portal

Vālenz Health®

Industry

Maximizing Value and Efficiency for Health Plans

Unlock Higher Savings with  
Data-Driven Cost Containment

Leveraging the VMS claim repricing methodology, we ensure defensible, market-supported reimbursements when members receive care beyond contracted, in-network facilities and providers.

With operational cost intelligence and expertly curated datasets informed by advanced analytics, our OON 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 defensible, transparent, and consistent for everyone.