Compare ABN Assistant vs. AppealsPlus

Medical necessity denials represent a significant financial burden for healthcare providers, incurring costs that can reach into the millions annually due to write-offs, along with the expensive labor involved in investigating and contesting these denials while addressing patient inquiries. Conversely, payers also face similar challenges in the claims management process, as they incur expenses from covering unnecessary medical procedures and treatments, as well as the resources dedicated to handling denial appeals, all of which do not contribute to better patient outcomes. Additionally, patients may suffer from excessive copays and other out-of-pocket expenses, coupled with a frustrating healthcare experience due to charges and services that are not warranted. To combat these issues, the ABN Assistant™ from Vālenz® Assurance equips providers with essential prior authorization tools to confirm medical necessity, generate Medicare-compliant Advanced Beneficiary Notices (ABNs) that include estimated costs, and effectively prevent over 90 percent of medical necessity denials by ensuring that the necessity is validated before any care is administered to the patient. By utilizing this system, providers can enhance their financial stability while improving patient satisfaction and care efficiency.

AppealsPlus™ is an innovative cloud solution designed to automatically assess ERAs, apply specific rules for categorizing questionable payments and denials into relevant work queues, and leverage dashboards alongside key performance indicators for effective quantitative management that aids in decision-making. As the regulatory landscape evolves swiftly, it often changes course unexpectedly, which can leave healthcare providers and their patients with minimal time to adapt. Uncertainty looms over whether patients will be financially prepared or willing to settle their bills post-procedure. A critical oversight in many studies, vendor offerings, and software solutions is the subjective nature of denial definitions, which can vary significantly among physicians, billers, and healthcare institutions. To address these challenges, we offer you and your team a tailored, four-week implementation phase aimed at customizing the solution to meet your unique needs. Following the completion of this initial phase, we invite you to reach out with any queries or issues that may arise, ensuring continued support and optimization of your experience. This ongoing relationship reinforces our commitment to your satisfaction and enables you to navigate the complexities of billing and denials with confidence.