Integrated Repricing Network

A solution for out of network claims that accesses 50+ national and regional PPO networks through a single interface, and uses routing optimization to achieve maximum savings.

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Out-of-Network Claim Repricing

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Integrate seamlessly with 50+ national and regional PPO networks through a single interface.

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Uses proprietary routing optimization to achieve maximum savings.

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Can be combined with additional layers of claims cost management technology, including clinical code edits and Record Review logic, prior to claim routing.

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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

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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.
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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.
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Reference-based 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

  • 24%

    per claim repriced in average supplemental PPO savings

  • 30%+

    average fee negotiation savings with sign off

  • 50%+

    average Medicare+ repricing savings per claim repriced

  • 2-4%

    average reduction in annual claims cost

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