ePricer - Automated Claims Repricing Services

The Issue
The terms of provider contracts are increasing in complexity as payers implement creative solutions that combine multiple payment methodologies in order to achieve greater cost savings. Without significant investment in improved technology, existing claims processing systems are ill-equipped to handle the sheer volume of claims and myriad of calculations necessary to accurately reprice claims in an automated fashion.

The Solution
Viant’s ePricer is a proprietary automated claims repricing service that consistently applies the correct contracted rate to each line item of every claim submitted for payment, thereby eliminating inconsistencies associated with manual claims adjudication processes. The result is decreased medical and administrative costs, as well as better network selection and improved provider relations.

Value Points

• More than 26 million claims processed annually for leading group health carriers and network operators
• More than 26,000 facility contracts and 1.4 million unique providers are loaded into the system
• Can be used for repricing claims from proprietary, supplemental, leased or wrap networks
• Ability to handle repricing complex contract terms across hundreds of networks
• Out-of-network claims can be routed to other Viant cost containment solutions

How it Works
Before receiving claims for repricing, all contract payment terms are pre-loaded into the ePricer system, then tested and verified. Provider claims are then routed to Viant via EDI feed. The system matches the claim to the right network based on the client’s configuration, identifies the correct provider for each claim using sophisticated matching logic and then reprices the claim based on the provisions of the contract. If a provider or network match is not found, the client has the option of utilizing Viant’s out-of-network claims cost management solutions to achieve savings.

Advantages

• Automatic claim pricing rate of over 98%
• Procedural accuracy of over 99%
• Financial accuracy rate of over 99%
• Processes 98% of clean claims within 24 hours
• Processes 99% of clean claims within 48 hours

Summary
Viant’s ePricer is the solution of choice for consistent, automated repricing of complex provider contracts. This powerful repricing application enables claims to be processed faster with increased accuracy, allowing payers to focus on provider and member relations.

To learn more about Viant’s ePricer automated claims repricing service, call us today at 800.820.5824.