Meeting the Challenge
Many organizations have legacy claims systems and processes that inhibit workflows and contribute to inefficiencies across their care continuum. Updating claim payment technology and integrating best practices can be a time- and resource-intensive process. But a highly efficient claims system can manage your administrative costs, increase provider satisfaction, and supply data to support more accurate assessment and analytics.
Valence services support a wide range of benefit plans including commercial, individual, governmental, and delegated risk plans. In addition, we manage changes to complex health plan-provider and/or provider risk-sharing agreements in a thorough and cooperative process.
Understanding each client and their claims systems.
We learn how our clients want to manage every aspect of claim payments, conducting a review of systems and processes to determine how to best streamline vital functions, track performance, and identify areas for improvement.
Adjudicate each claim correctly the first time.
Our approach is designed to reduce claim issues, analyze claim trends, and present findings to our clients for process improvements. Valence has a proven track record of meeting or exceeding the goals for accuracy measures.
Testing and review to ensure accuracy and drive continuous improvement.
Our processes for setting and testing benefit plan parameters, ensure that adjudication correctly maps back to eligibility data, provider data, provider reimbursement methodologies, and care management guidelines. All this is performed so that the health plan’s rate of auto adjudication can be as high as its processing rules allow.
Valence Medical Claim Payment Services include Claims Processing, Audit Services and Recoveries.