Many of today's insurance companies, health plans and TPAs perform a juggling act to keep medical costs under control while providing quality healthcare. Cost containment efforts can challenge time and resources when working with providers to determine the reasonableness of charges for a hospital stay, outpatient surgery, physician visit or other medically related therapy.
The Solution
Viant helps solve this problem by reviewing medical claims before the claim is paid and by negotiating a mutually accepted agreement on billed charges with the provider of service. Viant's Professional Negotiation Services (PNS) is one dimension of an overall cost management strategy that can be easily deployed with dramatic results. Since 1990, PNS has helped saved more than $1.7 billion for our clients.
How it Works
After a claim is submitted but before it is paid, Viant's professional negotiators contact doctors/facilities to negotiate a reduction in total billed charges. This is a claim-by-claim process. A mutual agreement on price between the provider and the negotiator is confirmed by return of a signed agreement to Viant. Claims should be referred to Viant for fee negotiation according to provider type and bill size prior to making payments to the provider, but after the bills have been completely reviewed for eligibility coverage.
Advantages
- Success rates of up to 59% on specialty claims
- Signed provider agreement on each out-of-network claim
- No balance-billing of members
- Low provider appeals
Summary
For those claims not eligible for savings through network access or re-pricing programs, Professional Negotiation Services is the solution of choice. Payers experience cost savings and enhanced member satisfaction from our provider-authorized adjustments to billed charges; providers receive timely payments; and patients benefit from lower out-of-pocket health care expenses.
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