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The Competitive Advantage of Market Value Pricing &
Charge Validation Analysis Greg Gaughan and Chad Countryman
Which is Why We Are Announcing…
Market Value Pricing Charge Validation Analysis Negotiations
The Evolution of SmartPrice Solutions2012 2014
NHQFairPayKPN, Square
One Solutions
FairPaySpecialty Bill
Review
FairPaySpecialty Bill
Review
Negotiations
Market Value Pricing
Charge Validation Analysis
What is Market Value Pricing?
Market Value Pricing analyzes bills line-by-line using data and analysis tools to determine a fair value for services performed.
For use on bills with higher dollar claims and more complex payment parameters
Market Value Pricing
Provider accepted payment data
Recommends the most accurate price on bills using
this type of data
Jurisdictional case law
Competitive market charge
Provider/facility cost & charge data
Implants and devices cost data
Legal benchmarks for charge limits
What is Charge Validation Analysis?
Charge Validation Analysis Charge Validation Analysis uses review bills via a robust technology system to identify inappropriate charges from up-coding, billing errors & more.
For use on bills with higher dollar claims and more complex payment parameters
Charge Validation Analysis
Uncovers inappropriate charges by looking for
these errors
Upcoding
Billing errors in detailed line items
Incomplete services
Undocumented charges
Unbundled charges
Provider-at-fault charges
Unrelated charges
Duplicate charges
Why do you need both?
Different States, Different ResultsWork Better as a Pair
Fairest PriceEach Review
Different Categories
SmartPrice Solutions Best Practices
O P T I M I Z Eyour cost containment stack in each state
based on performance
Best Specialty Bill Review Optimization States
AZ
UT
IA
MO
LA
The Benefits of Optimization - ArizonaTraditional
Projected Savings
$19,161,769
$1,125,755
$15,441,788
$300,165
$36,029,476
OptimizedProjected Savings
$52,969,390
$49,702,703
$966,144
$1,956,864
$343,678
Total
Primary Network
Secondary Network
Specialty Bill Review
Negotiations
58.5%Savings
Rate
38.3% Savings
Rate
CVA & MVP
Secondary Network
Secondary Network
*CVA: Charge Validation Analysis, MVP: Market Value Pricing
The Benefits of Optimization – New JerseyTraditional
Projected Savings
$25,727,254
$774,065
$10,703,226
$1,217,878
$38,422,423
OptimizedProjected Savings
$51,134,669
$45,720,000
$4,318,919
$971,440
$124,331
Total
Primary Network
Secondary Network
Specialty Bill Review
Negotiations
54%Savings
Rate
41% Savings
Rate
CVA & MVP*
Secondary Network
Secondary Network
*CVA: Charge Validation Analysis, MVP: Market Value Pricing
The Benefits of Optimization - MissouriTraditional
Projected Savings
$19,934,415
$919,346
$9,922,569
$497,190
$31,273,520
OptimizedProjected Savings
$47,215,973
$41,675,835
$2,088,252
$3,193,846
$258,040
Total
Primary Network
Secondary Network
Specialty Bill Review
Negotiations
50.06%Savings
Rate
33% Savings
Rate
CVA & MVP
Secondary Network
Secondary Network
*CVA: Charge Validation Analysis, MVP: Market Value Pricing
Key Takeaways
Savings Improve
40-50%on average
Strategic Positioning
State-By- State Focus
&
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Polling Overview
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