High-Dollar Claims Cost Savings Case Study

This case study details a high-dollar claim scenario involving a client with total billed charges of $1,143,444. The claim was processed through a third-party administrator, which identified unsecured savings of $60,782. The stop loss carrier requested a review by Vālenz® Health to assess potential inaccuracies in the charges. Vālenz conducted a comprehensive line-by-line bill review, utilizing expert coding and clinical review teams supported by AI. This review resulted in additional savings of $93,798, secured with provider signoff, ensuring no balance billing to the patient. The study highlights the effectiveness of Vālenz's Full Claim Review Solution, which validates the medical necessity of care and the accuracy of charges. The solution integrates various processes across the patient journey, emphasizing efficiency and transparency in healthcare. Notably, the fees charged to the stop loss company were 5% lower than those of the TPA vendor, despite the additional savings delivered.