VMS® Market-Sensitive Repricing

Ensure fair, defensible market-supported reimbursements

Fueled by the visibility, volume and value of data within the Vālenz® ecosystem, our VMS® market-sensitive repricing methodology accelerates fair, accurate and defensible claim repricing. Powered by the V3 repricing engine, the Valenz ecosystem brings you the data and transparency to support smart, strategic decision-making for your heath plan.

How It Works

Aggregating years of robust claims data from our 5,000+ provider network cases with industry-leading sources of payment, cost and charge based data sets together with biometrics and clinical data, the VMS® Repricing Methodology determines fair and acceptable reimbursements. Our detailed analysis goes further by analyzing quality, utilization and cost to identify opportunities for additional savings and deliver more actionable insight. For data integrity and timeliness, we continuously scrub and adjust the data as needed to ensure a fair market price for all services rendered.

Benefits of the VMS®:

  • Maximized discounts on low-dollar claims for optimal savings
  • More consistent, substantiated and defensible claims pricing
  • Faster turnaround from a rules-based engine that quickly defines claim pricing
  • Actionable insights to guide decisions, including data-mining capabilities that can reduce the cost of healthcare by identifying patterns and pinpointing high-performing providers with optimal cost structure

The V3 Repricing Engine is fueled by the three Vs of the Valenz ecosystem:

Visibility

Commitment to data transparency enables smart and strategic decisions

Volume

Years of historical claims data with biometrics and clinical insights

Value

Real-time quality, utilization and cost data to pinpoint savings opportunities

Ensure Compliance with No Surprises & Transparency in Coverage

Valenz provides an integrated array of solutions – all within one data-driven ecosystem – that empower self-insured employers and payers to comply with legislative requirements of the No Surprises Act and Transparency in Coverage regulations. We partner with you to provide protection from surprise medical billing, ensure price transparency for your organization and your members, and more.

Supported by the VMS® Repricing Methodology, the V3 Repricing Engine is one of many ways we partner with you to engage early and often for smarter, better, faster healthcare.

Call (866) 762-4455 or complete the form below, and we’ll be in touch very soon with more information.

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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.

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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