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Description

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.

Description

CareCost Estimate provides a solution for infusion centers and specialized medical practices to address a common patient query: what will the treatment cost? By selecting the medication, dosage, and insurance details, staff can utilize CareCost to swiftly determine the patient's out-of-pocket expense, typically within a 90-second timeframe. This calculation considers various factors such as Medicare Part B coinsurance, any applicable secondary insurance, Medigap, weight-based dosing, and potential vial waste (JW/JZ). Furthermore, it incorporates any manufacturer copay assistance programs and foundation grants the patient may be eligible for, ensuring that the figure presented reflects the actual financial responsibility of the patient. In addition to cost estimates, the platform provides insights into the prerequisites set by payers, including necessary prior authorizations, step therapy protocols, and site-of-care stipulations, all directly sourced from the payer's policy along with relevant links for reference. The pricing information is derived from the CMS Average Sales Price files, which are refreshed quarterly, and since the estimates are processed directly in the browser, patient data remains secure and does not get transmitted to external servers. Moreover, CareCost also offers complimentary resources related to billing and coding, including infusion CPT codes, J-codes, and modifiers, along with a quarterly Infusion Reimbursement Index to assist healthcare providers further.

API Access

Has API No 

API Access

Has API No 

Screenshots View All

Screenshots View All

No images available

Integrations

No details available.

Integrations

No details available.

Pricing Details

$1039.00/one-time/user
Free Trial No 
Free Version No 

Pricing Details

$189/month (first seat), $89/m
Free Trial Yes 
Free Version No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Customer Support

Business Hours No 
Live Rep (24/7) No 
Online Support Yes 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) Yes 
In Person Yes 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) No 
In Person No 

Vendor Details

Company Name

Vālenz

Founded

2004

Country

United States

Website

www.valenzhealth.com/valenz-assurance/abn-assistant/

Vendor Details

Company Name

CareCost

Founded

2026

Country

United States

Website

carecostestimate.com

Product Features

Medical Billing

Claims Processing No 
Claims Scrubbing No 
Code & Charge Entry No 
Compliance Tracking Yes 
Customizable Dashboard Yes 
Dunning Management Yes 
Invoice History Yes 
Patient Eligibility Checks No 
Practice Management No 
Quotes/Estimates Yes 
Remittance Advice Yes 

Product Features

Medical Billing

Claims Processing No 
Claims Scrubbing No 
Code & Charge Entry No 
Compliance Tracking No 
Customizable Dashboard No 
Dunning Management No 
Invoice History No 
Patient Eligibility Checks No 
Practice Management No 
Quotes/Estimates No 
Remittance Advice No 

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