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

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.

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

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.

Yes. Valenz offers guaranteed savings for behavioral and mental 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.

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.

We handle the CMS portal throughout the process and pay IDR fees upfront on behalf of the client to remove financial exposure and eliminate payment timing risk. Qualified databases (as opposed to CMS and PPO network rates) are used to ensure accuracy related to legislative requirements and reduce appeal rates, with all appeals managed directly by our expert team.