Claims are captured, repriced against the contracted rate, and routed on — using the clearinghouses and workflows providers already use.
Claims repricing adjusts a submitted claim to reflect the agreed contract rate, rather than a provider's standard billed charge. OpenNetworks reprices claims automatically as part of the adjudication cycle, using the rates and terms set directly between purchaser and provider — with independent validation available against the purchaser's own data.
Provider submits the claim through their existing clearinghouse — no new system required.
OpenNetworks captures the claim and applies claim editing rules automatically.
The claim is repriced against the contracted rate and passed to the purchaser or TPA.
Final adjudication is completed and payment issued per the agreed terms.
Providers submit claims exactly as they do today — no new integration required.
Follow a claim through processing, decisions, and appeals from a single view.
Repricing results can be validated against the purchaser's own claims data.
Repricing is included in the flat per-employee, per-month platform fee.
Providers' billing staff keep their existing workflows and clearinghouses — repricing happens behind the scenes.
Purchasers get repriced claims that reflect the contract they actually signed, ready for final adjudication.