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:
Commitment to data transparency enables smart and strategic decisions
Years of historical claims data with biometrics and clinical insights
Real-time quality, utilization and cost data to pinpoint savings opportunities