WellRithms mitigates financial risk associated with healthcare claims by delivering Sustainable Claims Pricing™ (SCP) solutions to the commercial and self-funded industries. Using data-driven methodology, backed by medical and legal expertise, WellRithms reprices claims accurately, fairly, and reasonably. WellRithms solutions eliminate the need for networks and make healthcare more affordable. We are steadfast with our work. Because WellRithms is committed to pursuing a fair price for healthcare services, we consistently outperform the competition by providing greater savings with client specific support and service.
WellRithms repricing is not an arbitrary percentage of Medicare or other benchmarks. Rather, our methodology is based on the common law principal of quantum meruit: as much as deserved. WellRithms determines a fair and reasonable reimbursement rate by analyzing what the provider generally accepts from all payer sources including commercial, federal, and private payers.
In addition, the core of our methodology includes a thorough audit of the claim using standard billing and coding edits followed by a line-by-line, physician-led review to determine that the bill accurately reflects the medical services provided and fair reimbursement that is legally defensible.
Ask About the WellRithms Savings Guarantee
WellRithms guarantees you will pay for what is fair and accurate.
We are backed by a captive insurance company that allows for the transfer of all legal and financial liability from the payer to WellRithms; thereby, guaranteeing the recommended payment amount. Shield Indemnification protects the plan and the member from the adverse impact of balance billing practices. Provider balance billing and collection threats are ineffective and unenforceable.
Group Health Solutions
Out-of-network providers commonly charge patients a higher rate and often an excessive amount for medical services rendered.
Accurate medical bill review requires medical understanding and interpretive expertise. The WellRithms team of experts provides in depth analysis to ensure the highest level of accuracy by identifying duplicate services, excessive charges, coding errors, and even abusive billing practices.
WellRithms delivers physician-led medical bill review using reasonable and customary pricing that reduces the liability of these high-dollar out-of-network claims for payers and patients.
Catastrophic medical bills represent a complex diagnosis which involves chronic, ongoing treatments. Treatments for these conditions are listed as essential benefits under the Affordable Care Act (ACA). Such diagnoses include, but are not limited to, organ transplants, orthopedic and pain procedures, complex cancer care, renal failure, congenital anomalies, congestive heart failure, and short gestation/low birth weight.
WellRithms works directly with employers and associated administrations to limit financial liability by reviewing and repricing this category of high-dollar claims. Careful bill review on a line-by-line basis assures the right price to achieve maximum savings.
In-Network Bill Review
Even in-network bills have been found to contain significant mistakes such as undocumented medical services, coding errors, and egregious charges.
When plan language and provider contracts allow, WellRithms reviews in-network claims to determine medical and coding correctness and appropriateness to find additional savings for self-funded and other qualified health plans.