Valence reduces administrative cost and improves outcomes with real-time web-based claims management. Specialized technology and integrated processes support rules-based, workflow-driven, payer transaction application for claims processing, audit services, and recoveries.
We highly automate the claim adjudication process to save time, increase claim accuracy, and expedite payment. The process is enhanced by the use of nationally-accepted claim edit system that is configured by Valence on a client-by-client basis.
Valence utilizes a rules-based claim engine that includes a very flexible benefit plan configuration sub-system. That sub-system allows the most complex benefit packages to be built and maintained so that the claim adjudication process can be automated and consistently paid correctly. Other sub-systems include member eligibility, provider demographic, provider reimbursement, billing, commission and check/EOP/EOB production. These sub-systems are integrated with one-another which further enhances the speed and accuracy of the claim adjudication process.
Claims Processing
Valence is experienced with processing professional, facility, and ancillary medical health claims, and has system capabilities to process dental claims and the professional component on vision claims. Our system maintains a history of each field of every claim and records of all claim forms.
Check Processing
Clients determine the frequency and method of disbursement, and Valence processes payments by check or electronic funds transfer (EFT). If this option is chosen by the provider, the provider receives an e-mail notification that funds have been deposited in their account and that they can log on to a secured web site to download the applicable Explanation of Payment. (EOPs). Reimbursement payments to members, when applicable, are settled by check production cycles.
Audit Services
Valence performs automated claims auditing, including a pre-release check review as well as customizable audit scenarios. The result can support improved claims management processes, cash flow, and compliance with applicable laws and regulations.
Recovery Services
Valence can identify and recover overpayments from all sources including providers, third-party liability companies, and reinsurance companies. We provide all necessary documentation to support recovery and work in a professional manner to successfully recover funds as quickly as possible.