As providers and payers position to protect their respective interests, managed care contracts get increasingly more complex. Adjudication of complex contract terms requires powerful solutions...like the Visium™ Pricer.

For over 10 years, we have been building innovative products that enable healthcare organizations adjudicate complex contract terms, group benefit and medical policies. And the results are clear: 99.5% of all managed care contracts we load achieve 100% electronic adjudication rate. Visium’s sophisticated contract load capabilities make the accommodation of complex contract terms easy by employing creative functionality and a friendly user interface.

By implementing Visium™ Repricer, healthcare organizations can significantly reduce the amount of claims that require manual review associated with complex provider contracts; in some case reducing the overall rate of manual intervention by as much as 80%. Improvement in the overall payment process enables organization to reduce the overall number of claims that need to be pended as well as the amount of time it takes to pay pended claims.

The Visium™ Repricer enhances transparency by generating our unique “Process Trail” for each claim. The “Trail” explains in plain English how each claim was priced based on the business rules of each particular contract. Use the “Trail” for internal QA and/or share with stakeholders over the web to support the repricing logic.

LEARN MORE

Click here to learn more