Integrate seamlessly with 50+ national and regional PPO networks through a single interface.
Can be combined with additional layers of claims cost management technology, including clinical code edits and Record Review logic, prior to claim routing.
Uses proprietary routing optimization to achieve maximum savings.
The ability to customize out of network claim management using three primary repricing models, including PPO Repricing, Cost-Based Fee Negotiation Services, and Reference Based Repricing.
Streamline Out-of-Network Repricing
Out-of-network PPO management
Provide access and EDI repricing to our AccessPlus Supplemental PPO Repricing program for the management of claims that fall out of the primary network. This program includes 50+ PPO Networks totaling access to over 4,500 hospitals and 900,000+ provider locations nationwide.
Cost‐based fee negotiation services
Establish a baseline for fair and rational reimbursement with cost‐based benchmarks that can be utilized for both in‐network and out‐of‐network claims.
Reference-based claims repricing
Alternative solution to price out of network claims using reference based repricing models. Can be used to gain savings on claims that fall outside of repricing networks, or provide additional savings to available repricing.
Providing Measurable Value
per claim repriced in average supplemental PPO savings
average fee negotiation savings with sign off
average Medicare+ repricing savings per claim repriced