Every claim is paid against the rate and terms already agreed between purchaser and provider — applied automatically, not re-negotiated claim by claim.
Reimbursement management is the process of applying the correct payment rate and terms to each healthcare claim. OpenNetworks automates this by matching every claim against the contract already agreed between purchaser and provider, so payment amounts stay consistent and predictable — instead of depending on manual review or a carrier's own fee schedule.
Every claim is matched to the correct rate schedule and payment rule automatically, based on the agreed contract.
Pre-authorization thresholds and audit rights are defined up front, so exceptions are resolved against known rules.
Every reimbursement decision is traceable back to the specific contract term that produced it.
OpenNetworks is paid a flat fee — never a percentage of what it reimburses or saves.
Employers and TPAs get payment amounts that match what was actually contracted — no surprise adjustments after the fact.
Providers know their effective rate before submitting a claim, instead of finding out months later.