Medical Solutions
Dynamic medical claim solutions, to the next power
Find the overlooked opportunities to maximize savings.
Too often significant savings are lost due to the traditional, linear approach to out-of-network claims management that focus only on the first discount.
We’re changing all that. Trust our team and our ExpionIQTM platform to revolutionize your approach and maximize the value of healthcare dollars for commercial, group health, auto, workers comp, and Medicaid payors.
Our dynamic approach goes above and beyond, across all options, to see the big picture, and uncover hidden savings. Our innovative suite of tools with AI-driven optimization combined with our unmatched negotiation expertise give you the ultimate control over your claims.
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Top-Tier Post Payment Support
Our experienced negotiators utilize innovative ExpionIQTM pricing tools to reveal essential insights that allow you to secure market-leading discounts, prevent balance billing, and virtually eliminate appeals through a comprehensive suite of services:
- Maximize your results with our
- Post-payment appeals including white-glove person-to-person negotiations and proprietary direct-to-provider agreements
- NSA and state balance billing support and process compliance
- Expertise in both pre-pay and post-pay negotiations
- Member support including the ExpionME member app for concierge-level balance billing support
AI-Driven Repricing Optimization
Transform your claims pricing with ExpionIQ, the advanced engine that leverages proprietary and industry data for unbeatable repricing solutions. Maximize savings and minimize disputes effortlessly.
Ready for a revolution in claims management? ExpionIQ’s SaaS licensing offers unparalleled control and transparency, ensuring your strategy is both effective and efficient. With our volume-based pricing, you’ll enjoy significant cost advantages over traditional models.
Unlock the future of efficient claims pricing now with an ExpionIQ SaaS license.
Premier Payment Integrity Solutions
ExpionIQ’s sophisticated algorithms deliver unmatched efficiency in uncovering savings across a multitude of critical scenarios. From rooting out fraud, waste, and abuse, to ensuring billing and coding regulation compliance, from navigating the complexities of payment guidelines to managing episodes of care and applying contracted rates with automated precision and unparalleled accuracy.
Compliant Pricing Solutions
Stay sharp and stay ahead. Our always evolving suite of solutions help you adapt to the changing regulatory environment. From a proprietary Medicaid pricing algorithm, to federal and state balance billing laws, we make sure you’re always in compliance.
We are experts in helping clients navigate No Surprises Act (NSA) compliance. NSA Navigator is a complete end-to-end solution to meet your NSA compliance needs.
Advanced Intelligence, 24/7
Get a clear and unmatched view anytime, anywhere, so you’re always ready to take action. ExpionIQ’s advanced analytics suite provides deep insights and a transparent understanding of your performance data in real-time to help you strategize like never before.
With our unprecedented approach you’ll uncover exclusive insights into discount rates, benchmarks, success rates, and even pinpoint resolution challenges right down to the claim level.
Let’s get started today with the only system custom-designed to help you make the intelligent decisions you need to drive growth.
Go Deeper with Medical Bill Review & Audit Services
Boost your savings on high-dollar, out-of-network claims.
Our expert team of auditing professionals is unrivaled in their ability to help health plans, third party administrators (TPAs), managing general underwriters (MGUs) and reinsurance carriers of all sizes, avoid paying unnecessary costs.
We’ll go above and beyond to help you identify coding errors and discrepancies in charges to ensure you only pay the appropriate reimbursement with detailed line-item auditing.
Get started with:
- Complimentary Prescreens
- Billing Error and Coding Review
- Reimbursement Validation Review
- Reasonable and Customary Review
- Supplemental Reviews (Medical Necessity, Experimental, and Level of Care)
