Building Blocks to Help Healthcare Payors Thrive in Our New Normal

Network-Based Services: Solid Relationships and Customized Solutions

Strong provider relationships are at the foundation of Claritev’s network. We directly contract with more than 99% of the one million providers in our network. We’re always mindful of these healthcare professionals and facilities.

Payors also have the flexibility to structure their own networks to fit a changing healthcare environment. We can help them:

• Do a complete build.
• Expand into a new service area.
• Fill location or specialty gaps.

Analytics-Based Services: Data Guided and Provider Accepted

Economic uncertainty may force many healthcare payors to re-evaluate their out-of-network cost containment solutions. With many providers being stretched to their limits, a payor’s strategy shouldn’t result in provider abrasion.

Taking cues from data, Claritev helps payors strike a balance between healthcare savings and member satisfaction, while preserving provider relationships. Payors have the flexibility to arrange or combine services, such as:

• Cost-based pricing: Delivers fair, consistent and transparent pricing of hospital and other facility claims—with wide provider acceptance.
• Negotiated agreements: Uses sophisticated financial benchmarks to drive agreements that offer members more protection from balance billing.
• Other pricing methodologies: Offers time-honored methodologies for reducing out-of-network facility costs.

Payment Integrity Services: Automation and Expertise

With changes in claim volume, new codes and unfamiliar claim scenarios, payors may start seeing an upswing in billing issues. It can be challenging to stay on top of these issues, especially if payors are also facing staff reductions. Claritev can help keep proper payments on track. We go way beyond static automated approaches. Our rich databases and clinical experts combine to identify complex issues before payment.

We are always evolving. Our analytical programs have more than 300 million code combinations and are continuously refined. Plus, our doctors, clinicians and coders offer accelerated reviews when appropriate. This combination of technology and the human touch can better tackle unique situations related to the COVID-19 outbreak.

Because we take a pre-payment approach, we can help a payor identify unusual billing patterns or complex issues before payment. Addressing issues before payment can translate into savings as payors begin to see an increase in claims.