How to Make Sure Claims Deliver to Payers With REPRICITY?

WHAT IS REPRICTY??

An independent, innovative medical claim repricing tool that offers employers, hospital systems and networks control & transparency within medical claims repricing. REPRICITY facilitates employers with direct relationships to hospital systems with the flexibility to use any TPA along with additional claims routing functions to other third-party vendors for subsequent repricing such as Referenced Based vendors and other PPO networks. REPRICITY provides a 100% automated claim repricing process with a guaranteed 24hr turnaround and 98% first pass accuracy rate with complete claim reconciliation.

HOW CAN REVELOHEALTH BENEFIT YOUR ORGANIZATION?

? Reprice any network claim, regardless of contract complexity including domestic fee schedules, case rates, per diem, bundled payments, direct contracts and provider carveouts. Our system dynamic is up to date with the most recent CMS claims. Outpatient claims – ASC (ASC pricing) Hospital (APC pricing) – RH procures both from a live vendor.

? Build customized fee schedules to change with the market, i.e., Medicare.

? TPA clients have online access to their claims data 24/7 giving you more control.

? Ensure network quality and accuracy by processing adds/deletes/changes within 24 hours.

? Receive claims directly from your TPA(s) or network providers depending upon your preference via a Payer ID procured customized for your need. Administer multi-tiered repricing and work closely with TPA so they know how to read indicators to understand where benefits are applied.

? Change TPAs without affecting your claim repricing as we are TPA agnostic.

? Create automatic claim queues to maximize par (participating provider) claims repricing versus non-par proactively instead of exhaustive reviews days to weeks after claim posting has occurred delaying payment.

? Share data elements captured from claims with our clients enabling them to update their own provider data management systems.

? Provide predicative and prospective claim modeling with analytics to improve outcomes in real-time.

? Create standalone repricing reports to demonstrate repriced savings independent of TPA claims adjudication edits or payer estimations.

TOP 10 ADVANTAGES OF USING REVELOHEALTH’S REPRICITY SOLUTION TO REPRICE CLAIMS:

? Control over all aspects of the repricing process from beginning to end.

? Improve quality and accuracy of claim repricing. Client saw an 86% reduction in call center volume due to claim pricing accuracy.

? Repricing is our core competency backed by years of industry experience.

? Understand and reprice complex provider contracts without slowing the overall claims process. Client saw 59% reduction in rejection rate.

? Access repriced claims data within 24 hours of processing versus industry standard of weeks.

? Provide full transparency & complete control of data/process offers clients the ability to easily change TPA’s when desired without losing any data or typical run-out concerns.

? REPRICITY takes raw and repriced claim data to manage total cost of care, provider rate changes, 360 view of claim lifecycle and dozens of other customizable reports.

? REVELOHEALTH can easily work with downstream vendors including wrap networks, reference-based pricing, bolt on products or special vendors specific to unique clients. Once we are fully implemented with TPA – RH can load a new client into our application and be ready in two weeks.

? Offers services outside of repricing to help maximize network access and performance including network contracting, credentialing, and overall network analyses.

? Customize every aspect of the repricing process including workflows, matching logic, reports, to meet our clients’ needs.

Media & Marketing Contact: [email protected]