GROUP HEALTH
SOLUTIONS
WellRithms guarantees you will only pay for what is fair and accurate.
Experience Guaranteed Savings with Harmony™ by WellRithms: Your Solution for Accurate Medical Claim Pricing
Harmony™ by WellRithms is a comprehensive solution for group health payers looking to stop overpaying for healthcare. Our suite of products, including Shield Indemnification, Out-of-Network Repricing, Inpatient Itemized Bill Review, and In-Network Review, are designed to help you get the most accurate pricing for your medical claims and achieve guaranteed savings.
BOLD | SMART | PROGRESSIVE | HUMAN | EXPERIENCED
In-Network Review
Our Classification, Edits, and Review (CER) process is designed to achieve savings for in-network claims.
On average, we achieve savings across all in-network claims through our pre-payment process. We also offer review and repricing services for other provider types, including outpatient, ambulatory surgical centers (ASCs), air and ground ambulance, and professional. Trust us to help you get the most accurate pricing for your medical claims and achieve guaranteed savings.
Our CER process includes:
Classification: Sorting and classifying 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.
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 Harmony™. 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.
Our scalable solution can accommodate high claim volume, and there is no minimum dollar threshold for Inpatient Itemized Bill Review. Additionally, our solution leverages Harmony™ 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.
Our In-Network Inpatient Itemized Bill Review solution is the perfect choice for payers who MUST control costs and improve the accuracy of their claims while paying only for the services they should as required by recent federal legislation.
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 Harmony™ CER to re-classify claims and remove services that are incidental, bundled, or inclusive to the primary procedure & include in facility capital costs
Ensures charges are consistent with the hospitals’ reported costs submitted to the government
Our out-of-network review and repricing services are designed to help capture savings on every claim and control the rising costs of out-of-network care. By using our services, you can bend the trajectory of health plan spend, solve patient balance billing issues, minimize provider appeals, and maximize savings with fair reimbursement. We realize an average savings of 75%.
Our out-of-network review and repricing services are a better option than rental PPOs for cost containment. Trust us to help you get the most accurate pricing for your medical claims and achieve guaranteed savings.
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
Patient balance billing disruption solved
Minimize provider appeals and maximize savings with fair reimbursement
A better option than rental PPOs for cost containment