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GROUP HEALTH SOLUTIONS

WellRithms guarantees payors will only pay for what is fair and accurate.

EXPERIENCE GUARANTEED SAVINGS 

WellRithms Is the Solution for Accurate Medical Claim Review and Repricing

WellRithms is a comprehensive solution for group health payors looking to stop overpaying for healthcare services. Our solutions for out-of-network repricing, inpatient itemized bill review, and in-network review are designed to help payors get the most accurate pricing for medical claims and are backed by Shield Indemnification™, the WellRithms' guarantee.  

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CLASSIFICATION, EDITS, & REVIEW  (CER)

Our Classification, Edits, and Review (CER) engine is designed to maximize savings for in-network claims.

On average, we achieve 6% - 8% additional savings across all in-network claims through our pre-payment adjudication. Trust us to help you get the most accurate bill review for medical claims and achieve guaranteed savings.

CER INCLUDES:

Classification: Our automated system sorts and classifies claims by bill type and place of service.

Edits: Clinical edits identify errors, duplicate services, excessive, abusive, and unlikely charges.

Review: A physician review scrutinizes the treatment provided to verify and confirm its accuracy.

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SUSTAINABLE CLAIMS PRICING

TM

For out-of-network and catastrophic bills.

At WellRithms, we are revolutionizing the way out-of-network and catastrophic healthcare bills are adjudicated. Our tailored system emphasizes sustainable billing practices, ensuring equitable costs. With our in-depth reviews and cutting-edge technology, we identify billing discrepancies, achieving an average of 75% savings.

 

This meticulous approach upholds our dedication to fairness and transparency, guaranteeing that healthcare providers and payors are respected and financial wellness is maintained. Trust in WellRithms for a balanced, just, and sustainable resolution to complex billing challenges.

  • Pre-payment review & repricing to capture savings on every claim

  • Control the rising costs of out-of-network claims

  • Bend the trajectory of health plan spend

  • Minimize provider appeals and maximize savings with fair reimbursement

  • A better option than rental PPOs for cost containment

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INPATIENT ITEMIZED BILL REVIEW  (OPUS)

Our pre-payment solutions are designed to ensure plans pay according to reimbursement policies.

OPUS™, our in-network inpatient itemized bill review solution, follows the guidelines of the National Uniform Billing Committee (NUBC) and the Centers for Medicare and Medicaid Services (CMS) most current reimbursement manual. We use OPUS™, our advanced technology to amplify the review process by automating data extraction from imaged itemized bills and mapping them into our system. This helps our physician review team to perform a thorough line-by-line claim review that is more accurate and 20 times faster than manual methods.

  • Claims adjudicated 20x faster and are paid more accurately than ever before

  • Scalable to accommodate high claims volume; no minimum dollar threshold for IBR

  • Leverages WellRithms' CER to re-classify claims and remove services that are incidental, bundled, or inclusive to the primary procedure and included in facility capital costs

  • Ensures charges are consistent with the hospital's reported costs submitted to the government

Our scalable solution can accommodate high claim volume, and there is no minimum dollar threshold for inpatient itemized bill review. Additionally, our solution leverages WellRithms' CER technology, which classifies claims and removes services that are incidental, bundled, or inclusive to the primary procedure and included in facility capital costs. This ensures that charges are consistent with the hospital's reported costs submitted to the government.

OPUS™  is the perfect choice for fiduciaries who MUST control costs and ensure plan assets are spent wisely. 

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