Capabilities
Viant's pre-payment solutions include Facility Bill Review Services and Professional Negotiation Services. These offerings combine technology-driven automation with human intervention to deliver claims cost management with industry-leading results. Before a claim is paid, out-of-network claims are evaluated, scored and directed to the most appropriate cost-containment service. The result is greater savings and lower medical loss ratios.

Facility Bill Review Services
Viant offers two solutions to help manage out-of-network facility medical claim costs. After an out-of-network claim is submitted but before it is paid, Viant reviews the claim and makes a payment recommendation pursuant to parameters that a client has established based on its policy limitations and exclusions.

Outpatient claims are reviewed using Viant's Facility Outpatient Usual & Customary Review Service database, which combines submitted charge data with the CMS Ambulatory Payment Classification system. Viant compares the charge submitted by the facility to a corresponding U&C value for the facility's geographic area at the percentile the client has selected and reports to the client the lesser of the submitted charge or the U&C amount. Viant reviews bills at each client's pre-specified parameters, including the percentile that will determine the reimbursement recommendation. 

Inpatient claims are reviewed using Viant's proprietary Cost-to-Charge (C2C) methodology, which is based on the mathematical relationship between costs and charges as reflected in the federal government's Medicare Cost Reports.  Viant uses the actual operating costs of each hospital and a consistent proportional margin allowance based on geographic norms and reports to its clients the results of its calculation for each claim.

Professional Negotiation Services
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. A mutually agreed upon price between the provider and the negotiator is confirmed by return of a signed agreement to Viant. Payers experience cost savings and enhanced member satisfaction from our provider-authorized adjustments to billed charges; providers receive timely payments and patient benefits from lower out-of-pocket health care expenses.

Summary
As out-of-network charges have become increasingly unavoidable, Viant's Pre-Payment Bill Management Services helps mitigate payers' exposure to costs associated with these claims. Through its Facility Bill Review Services and Professional Negotiation Services, Viant delivers its customers effective cost claims management, resulting in substantial savings on out-of-network claims.