Network Management Services

For payers to accurately and efficiently reimburse provider claims, it is imperative that they have a network management system in place with the depth and functionality to effectively manage thousands of contracts and tens of thousands of individual providers. Without significant investment in technology upgrades, many of today’s legacy payer systems are unable to meet the demands of the increasingly complex claims payment world.

Capabilities
Viant developed its Network Management Services solution to effectively manage the sheer volume of provider information and myriad of payment terms associated with healthcare claims. Viant's technology addresses the need for accurate, consistent and timely claims payment through a powerful repricing application and provider database that complements existing client systems. These automated solutions ensure that the right claim is matched to the right provider and the right network contract, and then repriced accurately, regardless of the complexity of contract terms. The result is significantly reduced administrative and medical costs, and improved provider and customer relations.

ePricer - Automated Claims Repricing
Before receiving claims for repricing, all contract payment terms are pre-loaded into the ePricer system, then tested and verified. The system matches provider claims 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.

Viant’s ePricer is the solution of choice for consistent, automated repricing of complex provider contracts:

• More than 26 million claims processed annually for leading group health carriers and network operators
• More than 26,000 facility contracts loaded into the system
• Automatic claim pricing rate of over 98%
• Procedural and financial accuracy rate of over 99%
• Processes 98% of clean claims within 24 hours
• Processes 99% of clean claims within 48 hours

eProvider - Provider Data Management
Provider records are pre-loaded into Viant’s eProvider system, which uses numerous unique data elements to ensure an accurate provider match. If the name on the billing statement has a different spelling from or is an abbreviated form of the official provider record in our system, an alias using the name on the billing statement is built into that record to ensure the accuracy of future record matching. With frequent updates being loaded into the system, Viant’s database contains the most accurate, up-to-date provider records, which payers can use to update and amend their provider directories.

Viant’s eProvider - Provider Data Management Services employs sophisticated matching logic and technology to harness the most up-to-date provider information available:

• 97% of provider data is auto-loaded, with less room for human error
• More than 99% accuracy of in-network matches
• System contains more than 1.4 million unique provider records
• Eliminates duplicate provider records
• Maintains complete provider demographic and network relationship information

Summary
Viant’s Network Management Services allows payers to accurately and efficiently reprice network claims without the administrative burden and associated costs of managing hundreds of networks. Our technology can help customers realize breakthrough performance metrics that also improve provider relations and reduce post-payment reconciliation requirements.

To learn more about Viant’s Network Management Services, call us today at 800.820.5824.