Vālenz Access
Open Solution

An integrated, dynamic approach to Reference Based Pricing, powered by VMSTM

Today’s self-insured employers need more innovative solutions to manage rising medical costs and improve health outcomes. Valenz Access Open Solution provides an open, non-contracted reimbursement approach with care coordination from NaVcare to reduce health costs, provide a new level of transparency and improve the overall member experience. It’s an excellent alternative to standard reference-based pricing (RBP) agreements.

Corporate employees viewing data

Fueled by analytics that blend payment, cost and charge-based data

Valenz Access 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 Access Open Solution also leverages the VMSTM 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 Access Open Solution delivers many advantages:

  • Cost Control: Fair, acceptable market pricing based on geography
  • Defendable Reimbursement Methodology: Reliable, algorithmic decision-making powered by VMSTM, 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.

Get Started Today

Where other companies limit services to network design or care management, we go infinitely further: We bring member-centric services and data-driven insights into the patient journey, connecting the dots at every step for lower-cost, higher-quality healthcare.

Contact us today and we will provide a real-life view into the network savings your organization will experience with the Valenz Access Open Solution. Engaging early and often for smarter, better, faster healthcare – that’s the Valenz promise.

Complete the form below or call us at (800) 834-2312 to get started with Valenz Access today.

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Valenz Access Solutions Suite

Explore the full breadth and depth of customizable, cost-saving options available in our Access Solutions Suite:

Access Contracted Network

Builds a new provider network to improve access, drive a higher standard of care and increase savings.

Access Contracted Networks are rigorously vetted, quality-first networks of top-performing physicians, hospitals and ancillary providers. We use advanced cost, quality and outcomes analytics to custom build and continuously optimize your high-value, high-performance contracted network.

Access Navigated Network

Navigates care to in-network providers for lower costs with better outcomes and enhanced member experiences.

Access Navigated Networks add NaVcare care navigation for improved in-network utilization to enhance savings and performance. NaVcare provides a single point of entry with high-touch member onboarding and guidance to immediately drive engagement and elevate the member experience.

Access Open
Solution

Maximizes plan dollars with a non-network reimbursement strategy that fosters equitable provider relationships.

Access Open Solution, an open, non-contracted reimbursement approach with NaVcare, provides an excellent alternative to standard reference-based pricing agreements. Our model provides transparent quality and outcomes data for fair, defensible and consistent reimbursement recommendations.

Access Assured
Payment

Eliminates the risk of balance billing, member disruption and provider friction for the majority of your claims.

Access Assured Payment delivers assured payment options for Access Open Solution, Access Navigated Network or Access Contracted Network. We blend payment, cost and charge-based data with biometrics and clinical data for fair pricing, integrating comprehensive bill reviews to ensure accuracy.

Access Amplified

Provides an out-of-network solution with care navigation and assured payment for secured savings.

Access Amplified is an out-of-network solution with NaVcare and comprehensive bill review with provider signoff. We steer members to high-quality care at fair, reasonable costs and secure appropriate, accurate charges for every out-of-network claim, resulting in significant savings improvement.

Access MEC Solution

Replaces wrap networks with Minimum Essential Coverage for assured payment and minimal risk of balance billing.

Access MEC Solution is an open-access network solution, complete with assured payment options that minimize member disruption and provider friction for the vast majority of claims. Includes access to high-quality providers and facilities at fair, reasonable costs for substantial savings improvement.

Access Eco Complete

Replaces high-cost contracted network plans for long-term savings and enhanced member engagement.

Access Eco Complete is a fully integrated ecosystem to optimize the value of your Access choice and achieve total savings improvement of 20-40%. Includes supporting solutions for navigation and care management, claim management, high-dollar claim protection, pharmacy solutions and more.

Experience the Synergy

When we say the Valenz ecosystem is comprehensive, we mean it. With a complete selection of fully integrated wraparound solutions to complement the core solutions featured below, we deliver benefits far greater than the sum of all these parts individually.

Vālenz Access

Combine a quality-first provider network or open solution with a range of customized, data-driven services from the Access Solutions Suite.

Vālenz Care

Guide members to better care and outcomes at lower costs, for you and for them, with RN-led, triple URAC-accredited care management.

Vālenz Claim

Reduce costs and ensure accurate payments with comprehensive bill reviews and repricing methodologies, integrated analytics, and more.

Vālenz Assurance

Improve coding, reimbursement assurance, auditing, claim accuracy and compliance monitoring, all while saving time and costs.

v-Lens

Use advanced, drill-down analytics and predictive modeling to continuously disrupt the cost curve without compromising quality.

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