Software

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-NetworkClaim Repricing

  • 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

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24 %

per claim repriced in average supplemental PPO savings

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30 %+

average fee negotiation savings with sign off

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50 %+

average Medicare+ repricing savings per claim repriced

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2-4 %

average reduction in annual claims cost

Our outcomes

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Infographic

We Deliver So You Can. The Streamlined Patient Communications Solution

Infographic

We Deliver So You Can. The Streamlined Patient Communications Solution

Learn how a platform for the full spectrum of patient communications accelerates revenue, lower cost-to-collect, reduce bad debt and boost the patient experience.

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On-demand Webinar

Enabling Patient Success With SmartPay Plus™

On-demand Webinar

Enabling Patient Success With SmartPay Plus™

Learn how efficient patient payment options can help improve patient retention and loyalty.

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Fact Sheet

Accelerate Collection and Increase Patient Satisfaction with SmartPay Plus

Fact Sheet

Accelerate Collection and Increase Patient Satisfaction with SmartPay Plus

Learn how SmartPay Plus can help provider organizations increase patient payment collection, while improving the patient financial experience.

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