Vālenz Claim

Ensure a clean claim workflow and reduce medical and administrative costs.

Clinicians interacting with patient/plan member

Vālenz Claim delivers a full-service, fully integrated approach to routing and repricing medical claims, both in-network and out-of-network. Our model weaves robust analytics and wrapround services into claim workflow for efficiency in cost and process – lowering your total health plan spend, improving claim outcomes and enhancing the member experience.

Our certified coding and repricing teams engage with streamlined claim support, including comprehensive and complete bill review, identifying additional negotiation opportunities with the provider and leveraging multiple cost-based data points. We assume the roles of appeals manager, provider negotiator, line-by-line bill reviewer and payer of additional charges, delivering a 90% average success rate on out-of-network claims.

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How we reduce medical and administrative costs while balancing your bottom line:

Network repricing
and claim routing

• Full integration with providers
• EDIs with 65+ PPO plans
• Multiple clearinghouse EDIs

Cost management, specialty solutions, care compliance

• Multiple cost reduction methodologies
• In/out of network management
• Guaranteed cost solutions

Payment assurance,
member experience

• Clinical and coding edits
• Claim scrubbing integration
• Minimize member disruption

Total insight to ensure appropriate payment

Vālenz ProteKHt™ ensures appropriate and accurate charges are accounted for on every line of every claim, correcting unnecessary, unrelated, irregular or inappropriate medical billing while enhancing the claim management process.

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v-Lens

360° Analytics to Drive Higher Quality at Lower Costs

As a proprietary layer of the Vālenz^® ecosystem, v-Lens is fueled by actionable, drill-down data that empowers you to focus on optimal quality, utilization, cost and outcomes.

Claims Review · Trend Analysis · Risk Analysis · Month End Reports · Plan Modeler · Benchmarking · Cost Driver Comparisons

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V³ Repricing Engine

Ensuring fair, defensible market-supported claim reimbursements.

For accurate claim repricing, the V³ Repricing Engine aggregates years of robust claims data and uses the data-rich VMS^SM Repricing Methodology to identify patterns, facilitate strategic decisions and control costs. Our detailed analysis goes further by identifying potential pain points and additional savings opportunities – creating value for the payer, provider and patient.

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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.