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.
How we reduce medical and administrative costs while balancing your bottom line:
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
• Clinical and coding edits
• Claim scrubbing integration
• Minimize member disruption
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
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.
Combine a quality-first provider network or open solution with a range of customized, data-driven services from the Access Solutions Suite.
Guide members to better care and outcomes at lower costs, for you and for them, with RN-led, triple URAC-accredited care management.
Reduce costs and ensure accurate payments with comprehensive bill reviews and repricing methodologies, integrated analytics, and more.
Improve coding, reimbursement assurance, auditing, claim accuracy and compliance monitoring, all while saving time and costs.
Use advanced, drill-down analytics and predictive modeling to continuously disrupt the cost curve without compromising quality.
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