In-Network Claims Cleaning, Review, and Repricing
Whether through preset discounts or averages based on average multipliers of Medicare, billing errors, anomalies, and abuse are often overlooked under the guise of set savings. WellRithms’ in-and-out of network review and repricing process makes sure that doesn’t happen.
Savings Impact
Up to 40% additional savings before PPO Reductions
Classifications, Edits, and Review
WellRithms doesn’t let “discounts” get in the way of fair, accurate pricing. Network claims are reviewed line-by-line using WellRithms’ Classification, Edits, & Review (CER) system before PPO discount is applied.
- Classification: sorts and organizes medical data, ensuring accurate categorization for further analysis.
- Edits: correct discrepancies, aligning charges with proper medical standards and billing practices.
- Review: scrutinizes system-flagged items to verify and confirm the treatment provided.
Inpatient Itemized Bill Review
Automated line-by-line review process amplifies the review process by automating data extraction from imaged itemized bills and mapping them into our system.
- 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 & included in facility capital costs
- Ensures charges are consistent with the hospital’s reported costs submitted to the government
Want to Know More?
Let’s talk about how we can level the paying field by fighting for fair reimbursement.
