Professional Negotiation Services

The Issue
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.

Value Points

• Strong savings performance across the full spectrum of bill types, including small bill claims
• Good entry point for pre-payment cost control solution
• Product can be used in conjunction with Viant’s overall solutions
• Web-based negotiation capabilities
• All 100+ Viant negotiators have medical or provider side background and are successful on 34.8% of cases reviewed
• Negotiating position based on a combination of medical expertise, cost information and knowledge of the provider’s discounting history

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

• Average discounts of 25%
• 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 Negotiations 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.

To learn more about Professional Negotiation Services, call us today at 800.820.5824.