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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Out-of-Network Fee Negotiation

Our experienced negotiators utilize our innovative ExpionIQTM pricing tools to reveal essential insights that allow you to secure market-leading discounts, prevent balance billing, and virtually eliminate appeals.

Maximize your results with our white-glove person-to-person negotiations and proprietary direct-to-provider agreements.

AI-Driven Repricing Optimization

Raise your savings game with AI. Our ExpionIQTM engine integrates and analyzes proprietary and industry benchmark data to find the unmatched repricing solutions for each claim, to maximize savings and minimize disputes.

Cross-Vendor Dynamic Price Optimization

Take price optimization to the next level. For unrivaled, comprehensive price solutions, choose Expion Health to be your central clearinghouse to find the best discount across all repricing partners in your stack

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.

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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)