Pre-Payment Bill Management Services

Whether due to emergent care, provider preference or geographical limitations, health insurance plan members engage out-of-network care at a rate of $60 billion in claims annually. As a result, national and regional payers have exposure of 10% to 15% of their total paid claims volume at the more expensive, out-of-network rate. Viant’s claims costs management solutions help its clients maintain a competitive edge while minimizing the “leakage” associated with out-of-network claims.

Capabilities
Viant’s pre-payment solutions include UCR Facility Repricing 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.

UCR Facility Repricing Services
Viant offers two solutions to help reduce facility medical claim costs. After a claim is submitted but before it is paid, Viant 'reprices' the claim to the usual and customary value. All inpatient facility bills are reviewed at the revenue code level utilizing the hospital's own cost data. A three-tiered methodology is used to evaluate outpatient bills. Both support benefit plan language, which states that medically necessary goods and services consumed will be paid at the lesser of the usual, customary or reasonable charge. Proactive ‘Patient Advocacy’ defuses potential balance billing of the member.

For payers looking for strong savings performance on inpatient and outpatient facility bills, UCR Facility Repricing is the solution of choice:

• Most aggressive pre-payment cost control option, with strong savings performance
• Average discount rates range from 24% to 33% depending on service mix
• The average dollar savings equates to approximately $6,024 per claim for inpatient claims and approximately $1,346 for outpatient claims
• Proactive 'Patient Advocacy' communication to defuse potential balance billing
• All Viant repricing methods are quantitative, objective, applied consistently and defensible

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.

For those claims not eligible for savings through network access or repricing programs, Professional Negotiations Services is an equally powerful cost-saving option:

• Strong savings performance across the full spectrum of bill types, including small bill claims
• Discounts of up to 23% on inpatient claims
• Signed provider agreement on each out-of-network claim, with no balance-billing of members
• Good entry point for pre-payment cost control solution
• Product can be used in conjunction with Viant’s overall solutions

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 UCR Facility Repricing Services and Professional Negotiation Services, Viant delivers its customers effective cost claims management, with the following key benefits:

• Decreased medical costs associated with out-of-network claims
• Strong savings performance across all bill types
• Success rates up to 60% on specialty claims
• Low provider appeals - signed agreement on each negotiated claim
• No balance-billing of members

To learn more about Viant’s Pre-Payment Bill Management Services, call us today at 800.820.5824.