Our Services
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.
Our Methodology
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.
The WellRithms Shield™ for Group Health:
Total Indemnification
WellRithms is pleased to offer the most innovative cost-containment solution available to the self-funded market, The WellRithms Shield. Developed by leading ERISA attorneys and medical claim experts who work with payment dispute issues daily, the Shield is an ERISA-compliant product that deals with high-dollar medical claims and COMPLETELY PROTECTS the member from balance billing abuses with guaranteed savings.
Have you paid more than you thought was reasonable on a claim due to a minimal discount from a wrap network in order to minimize member and plan disruption? Are you paying monthly fees for legal defense which is both ineffective and costly? If the answer is yes to either of these questions, then you need the WellRithms Shield. The only way to protect the plan AND the member is for a third party to intervene as a co-fiduciary and indemnify both the plan AND the member by taking over the liability for the payment, which is what the Shield does.
Email info@wellrithms.com today for a demo on how the Shield can work for you.
Sustainable Claims Pricing™ (SCP)
Out-of-Network Bills
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 Bills
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 Audit
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.
Usual, Customary, and Reasonable (UC&R)
Determination Anchor
Sometimes disputes arise over the right price for medical services rendered with complex claims and a resolution anchor is needed.
The physician-led WellRithms team will provide line by line bill review and repricing to produce a UC&R determination anchor to facilitate a dispute resolution.