Evidence-Based Medical Settlement Intelligence
Resolvix transforms complex medical billing into defensible, probability-weighted settlement strategies — reducing cycle time, payout volatility, and dispute escalation in workers' compensation claims.
Built for Carriers • TPAs • Self-Insured Employers • WC Managed Care
Total Billed
$43,270
State Allowed
$7,670
Rec. Offer
$4,985
Expected Payout
$3,340
CPT
Billed
Medicare
Allowed
Variance
99204
$1,850
$260
$455
407%
73030
$620
$44
$77
805%
29827
$19,900
$1,620
$3,402
585%
64415
$2,950
$135
$284
1039%
75% of Allowed
$5,752
58% acceptance
65% of Allowed
$4,985
67% acceptance • Fast Pay 10d
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State rules vary, Medicare baselines shift, and methodology inconsistencies create negotiation friction.
Adjuster discretion leads to inconsistent settlements and payout variance.
High-variance claims increase dispute probability and reserve uncertainty.
Three pillars that transform medical bill negotiation into defensible strategy.
Medicare-anchored + state-aligned fee schedule computation with audit traceability.
Probability-of-acceptance modeling across structured offer tiers and payment terms.
Provider outlier detection, CPT clustering, variance scoring, and portfolio-level exposure tracking.
Structured bill intake from provider submissions.
Methodology-aligned allowed amounts with fee schedule logic.
Multi-tier offers with acceptance modeling and fast-pay uplift.
Full evidence packets, litigation risk scoring, and audit trail.
Results from simulated portfolio modeling across carrier and TPA environments.
↓ 30–40%
Average negotiation cycle time
↓ 15–25%
Probability-weighted payout variance
↑ Acceptance Uplift
Improved structured offer acceptance modeling
↓ Litigation Exposure
High-variance claim detection before escalation
*Results based on simulated portfolio modeling.
Every calculation, recommendation, and decision is traceable, documented, and methodology-aligned.
Full audit trail of baseline methodology
State rule documentation alignment
Medicare crosswalk traceability
Line-level CPT justification
Counteroffer analytics
Litigation Risk Index scoring
Portfolio-level settlement optimization.
Standardized negotiation strategy across adjusters.
Reserve accuracy and payout forecasting.
Benchmark-driven provider engagement.
Feedback from senior claims executives and managed care directors.
"Resolvix turned fee schedule complexity into a clean, defensible offer strategy. Our adjusters finally have consistent methodology."
VP of Claims Operations
National Carrier
"The evidence packets dramatically reduced friction in provider discussions. Dispute escalation dropped measurably."
Director of WC Managed Care
Regional TPA
"Reserve accuracy improved once we standardized on probability-weighted expected values instead of adjuster estimates."
Risk Manager
Self-Insured Employer
Move from subjective negotiation to defensible, probability-weighted strategy.