Vālenz Claim

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

“The staff is extremely attentive to our needs, and the savings are incredible – even on catastrophic claims.”

Vālenz Claim delivers an integrated approach to routing and repricing in-network and out-of-network medical claims. Our model weaves analytics 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, identifying additional negotiation opportunities with the provider and leveraging multiple cost-based data points. We assume the roles of appeals manager, provider negotiator 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

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

SEE DATA DIFFERENTLY

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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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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Seize the Power of the Ecosystem

For smarter, better, faster healthcare

Realize greater return through the fully integrated Valenz ecosystem – a single-source, end-to-end platform that connects and analyzes cost and quality data across the full continuum of health administrative processes. Together and individually, our highly secure data systems provide analytic and predictive insights to substantially reduce medical costs and improve quality health outcomes. Our other products include:

Vālenz Care

Empowering members to move from reactive care to proactive population health management.

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Vālenz Access

Driving high-quality care, satisfaction and cost savings with high-value, client-centric provider networks.

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Vālenz Assurance

Delivering smarter, better, faster solutions for payment integrity and assured compliance.

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Vālenz Claim

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

“The staff is extremely attentive to our needs, and the savings are incredible – even on catastrophic claims.”