Medical bill review and repricing is a crowded space, but WellRithms is the only company in this growing healthcare market segment that actually assumes financial risk associated with disputed claims.
The centerpiece of our formula involves indemnifying group health plan sponsors and participants, as well as workers’ compensation payors. It is done through an innovative insurance captive solution that offers patients full protection from aggressive balance billing tactics and collection agency threats.
Our Shield Indemnification™ product is backed by AMI Indemnity, a legal entity that is certified to absorb the risk exposure for excessive claims away from payors and members. This novel approach differs from a single or group captive program, which insures risk on claims that haven’t yet occurred. Another noteworthy difference is traditional captives that pool covered lives in group health and workers’ comp plans do not manage the risk of individual bills. Our unique captive solution can be added to WellRithms’ bill review and repricing on a bill-by-bill basis with potential savings of 75% or more.
Perhaps best of all, patients who are already struggling to navigate a complex healthcare system, and afford important treatment and medicine, can have peace of mind that they will never be at risk financially or legally for a balance bill. This captive indemnification program offers us a game-changing competitive leg up.
Other key differentiators for WellRithms are built on a combination of technical precision and human expertise that allows us to offer the industry’s most:
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Rigorous and precise bill review. Physician-trained algorithms drive our payment integrity platform, scrubbing every bill at the line-item level for excessive, inaccurate, and unjustified charges. Most of these issues are caught and corrected by our automated system, which features the most advanced technology for automating this process.
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Unsurpassed physician bill review expertise. Physicians and surgeons who understand the medicine behind medical billing flag and review complex bills that require more attention. While other companies use medical coders and nurses to perform this task, the only way to ensure appropriate medical bill review is to build into the process a much higher level of expertise.
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Accurate and advanced repricing of bills. Our unique Sustainable Claims Pricing approach surpasses obsolete Reference-Based Pricing multiples of Medicare. The reimbursements we secure are based on actual hospital costs, allowing for pricing that is fair and legally defensible.
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Legal expertise. WellRithms has more than 25 years of experience defending fair reimbursement in courts throughout the country and setting case law. U.S. courts continue to rule that our reimbursement methodology is fair and reasonable.
For more information visit https://www.wellrithms.com.
