PPO repricing solutions to reduce turnaround time and overall costs
PCH Health provides advanced PPO repricing solutions tailored for TPAs, health plans, and cost containment companies. Our claims repricing solution integrates seamlessly with regional and national PPO networks through a single interface, streamlining claims processing and driving substantial cost savings.
Our proprietary optimization tools can maximize your savings. Our smart edit encompasses HIPAA compliance, clinical guidelines, coordination of benefits (COB), and client-specific customizations enable to increase payment accuracy.
Claim aggregation
Collect claims through PO Box, Web, DDE, Fax, Email, Mobile App, EDI, Mail Room, or Scanning.
Extraction and routing
Sort, batch, extract data, and route it accurately.
Enrichment
Apply business rules, validate data, and perform pre-edits for accuracy.
Storage, archival & retrieval
Securely store data with easy archival and retrieval.
Decisioning
Manage claim rejections, resubmissions, repricing, denials, and communications.
Output, shipment & dashboard
Provide detailed outputs, efficient processing, and comprehensive dashboard reporting.
Preferred payer organization repricing solutions to prevent loss of claims
PCH Health’s PPO repricing solutions prevent loss of claims & enable daily audit control and audit trails to manage critical claims and specific claims routing to various networks. We offer reconciliation at both the claim and file levels.
Our rules-based hierarchical routing engine efficiently routes claims to primary networks, secondary networks, and cost-containment vendors before loading claims into the payer’s adjudication platform. Here is how an integrated repricing network helps you:
- Network-agnostic compatibility with all payers and providers
- Quick turnaround, with 90% of claims returned the same business day
- Comprehensive payment accuracy suite to maximize value
Overcome data vulnerabilities with PCH Health’s sophisticated provider and member matching.
Overcome data-vulnerability with sophisticated provider and member matching
Reprice any network claim, regardless of contract complexity, including domestic fee schedules, case rates, per diem rates, bundled payments, direct contracts, and provider carve-outs
>98%
First-pass accuracy
100%
Automated claims repricing
<24hrs
Turnaround Time
30-40%
Savings
Awards and Certifications
