Every payer knows that medical cost containment is a balancing act. With so many services and relationships to coordinate—coupled with rules and regulations that are changing faster than ever—complexity is unavoidable. When efficiency gains start to dwindle and resources become strained to the limit, program savings quickly evaporate. But we can help.
Medical cost challenges require the advanced performance and agility of the Conduent platform. By combining deep understanding of your business with the industry’s leading bill review software and service offerings, we can help you make the right decisions in an uncertain world and execute them quickly.
Strataware® Medical Bill Review Software
Strataware is best-fit software built for cost containment. Excellent integration with claims systems, PPO and specialty networks, utilization review systems, and e-billing technology make Strataware a powerful yet flexible platform for workers’ compensation payers and self-administered employers to expertly process bills in-house.
Provider Payment Solutions
Streamline provider fulfillment with an integrated payment solution. Conduent supports direct provider payments from within the bill review application. Payments are delivered fast, securely and in the provider’s preferred format, including electronic, paper check or check card.
Outsourced Medical Bill Review
The Conduent bill review service team provides comprehensive expert bill review services. Full-service outsourced bill review using the power of Strataware, in the hands of our expert staff, has set the standard for maximum net savings with low reconsideration rates. As our client, you’ll get access to high-quality services at more predictable costs, along with increased flexibility to meet changing regulatory requirements.
Bill and Data Intake Solutions
It’s true, the future belongs to data-centered strategies. The benefits of front-end bill processing pre-integrated with bill review are realized with an automated bill and data intake solution. Physical and electronic mailroom technology accurately extracts data and securely delivers it to our medical bill review platform, giving you actionable insights into bill status and workflows. View inventory data and alerts in the web dashboard and leverage end-to-end reporting to improve transparency and simplify your document processes for incoming bills.
Clinical Bill Review
Our Clinical Bill Review service will conduct a deep-dive analysis of medical records and associated documents for at-risk bills. Validating proof of services, medical necessity and reasonableness of individual charges produces an average reduction of over $150 per impacted bill.
PPO Network Management
Strataware clients benefit from our preferred provider network philosophy of access to all, ownership of none. We work with you to customize PPO network solutions based on national, regional and specialty network coverage. Using the constant feed of intelligence into our medical bill review platform, we calculate the impact of different network configurations to deliver optimal penetration, cost savings and patient outcomes.
IQ Analysis for Out-of-Network Repricing and Negotiation
IQ Analysis is our proprietary offering that delivers defensible, repeatable and transparent payment recommendations for out-of-network bills. We combine public data and unique claim elements to calculate appropriate reimbursement amounts and secure a negotiated settlement averaging 65% off billed charges.