What if technology could eliminate the provider network?

DIRECT CONTRACTING using the Apaly Health software
can help accomplish this...

Built and designed to improve healthcare

The Apaly Health software has compliance and security embedded in its fabric, and has been tailored to deliver significant benefits with virtually no behavioral change.

HIPAA compliance

We've designed the software to be HIPAA compliant, and using SSO secure authentication with verified patient record access authorization, we address regulatory requirements, and more easily support integrations with HR and TPA systems.

Automated smart contracts

Streamlining efficiency and trust between parties through smart contract automation and execution translates into savings. We help to remove subjectivity, reduce errors, improve efficiency, and lower costs.

Identity verification

Our security framework uses individual identity verification to verify that each individual patient and doctor is who they claim to be. This functionality serves as the foundation for other core compliance and security functions.

No employee disruption

This is not a "No-Contract Reference Based Pricing (RBP)" model. We built the Apaly Health software to support upfront contracted rates between self-funded employers and providers. This way everyone is in agreement ahead of time, and there are no surprises.

A real network alternative

We've created an elegant solution to enable direct contracting nationally, to support quality and performance, and serve as the foundation for cost savings, employee satisfaction, and enhanced health and wellness.

Benefits advisors are key

We're making it easy for benefit advisors to look like heros in the eyes of their clients. Offering a direct contracted software solution that can help to eliminate their provider network lease, is one of the last point solutions that has been missing.

We feel like we've made an otherwise complicated process, SIMPLE.

Designed by industry experts, and built in conjunction with techie nerds.

Direct contracting at scale

WOW... A scalable solution to facilitate an unlimited number of direct relationships between hospitals, doctors, other healthcare providers, and self-funded employers, with each having the ability to define their own contract rates.

One account - many connections

The days of one-to-one direct contracts are over. With a single account on the Apaly Health software, many connections and contracts can be created between self-funded employers, hospitals, doctors, and other types of providers.

Name your contract rate

Self-funded employers, hospitals, doctor groups, and other types of healthcare providers each enter your own contract rates. Our proprietary contract matching algorithm will show you how much of the market you can expect to capture, based on the rates you entered, and then you can adjust and commit to the rates.

Contract matching algorithm

We were excited to integrate an algorithm into our software; not just because it sounds cool, but because it really made sense.

This software functionality is what makes it possible for self-funded employers and all types of healthcare providers to enter their rates once, and establish direct connections and contracts with many others using the software.

Direct contract = no networks

We enable self-funded employers and all types of healthcare providers to replace the provider network with a software solution that establishes direct contracts on a national scale. Our filtering mechanisms replaces the network features that are often valued.

Filters vs. networks

Contracted healthcare providers can be filtered and sorted based on cost, quality, utilization, outcomes, and more. We've partnered with data sources to help you facilitate this functionality and enable "network type" features, but through our direct contracting solution.

Digital payments

We wanted to make paying for services simple, efficient, and flexible. Based on the agreed upon contracted rates, payment can be automated through the software, or self-funded employers (or their TPA) can pay the provider electronically for the services that were delivered.

Embrace bundled payments...

We noticed that there seemed to be a disconnect between self-funded employers, and most healthcare providers, in relation to bundled payments. Employers, seemed to love it, but healthcare providers, not so much. We dove deep into this issue to see what we could uncover, and see how we could fix this.

At the end of the day, bundles are only "parts & services" that are grouped together and offered as a "package." It seemed that one of the main issues that most healthcare providers had with bundles, was that they were having trouble creating / defining and pricing them.

So, we decided to make it simple for healthcare providers to participate in bundled payments with self-funded employers. We created a tool that helps them price each "part & service" individually within predefined bundle categories, assess if their final consolidated price was reasonable, adjust, and then repeat.

Dynamic provider directory

Our employee app enables self-funded plan members to find the right contracted hospitals and doctors based on many factors: specialty, location, outcomes, experience, patient feedback, geolocation, and more. We are taking the provider directory to a whole new level.

Eligibility and prior authorization

Accessed directly through the provider's practice management/billing system, or directly through our provider web portal, eligibility and prior authorization delivers a real time confirmation of member coverage eligibility and service authorization.

Automated escrow

This is a key component of eligibility and prior authorizaton functionality, and ensures that the appropriate funds are available and released when services are delivered.

Automated claim repricing

Our proprietary claims repricing utilizes the agreed upon contractual rates that were individually set by each party, and ensures that claim charges and reimbursement are accurate.  

Provider credentialing

Our provider controlled repository of personal credentialing information supports dynamic "Green / Yellow / Red Light" credentialing determination based on terms defined between the self-funded employer and the healthcare provider.

Online claim viewer

Full transparency and visibility into all medical billing claims for employers, employees, providers, benefits advisors, and TPAs through access to all medical billing claim information with appropriate authorization.

Sales support tools

Tools to help benefits advisors and TPAs demonstrate the benefits of the solution to their clients including provider geographic coverage reports and cost savings analysis. Apaly Health can help you become a benefits hero!