Purchased/Referred Care (PRC)

Data and Claims Management

VyStream provides cost effective claims and payment processing for Self-Governed 638 Facilities.  Inpatient and outpatient hospital facility claims are re-priced according to Medicare-Like Rates (MLR).  Professional claims can be re-priced according to the provider contract or quoted agreement.  Utilizing MLR will reduce contract health expenses for hospital services and enable Indian Health Services programs to use the resulting savings to increase services for the American Indian/Alaska Native (AI/AN) patients on the PRC program.

VyStream offers a comprehensive approach to managing the data and claims process:

  • Proprietary, state-of-the-art auto-adjudication system
  • Timely adjudication of claims
  • MLR discounts for all eligible claims
  • Coordination of benefits
  • Recovery of overpayments
  • Accurate and timely provider payments
  • EDI transmission in accordance with HIPAA standards including electronic receipt of PO’s
  • ICD-10 compliance
  • Quality control review of claims and contracts
  • Data Imaging
  • Supreme Customer Service
  • Customized Reports
  • Complete access to all your data to compile your own statistics
  • Online access to patient claim information

Process Flow Diagram


We'll help you get on
the right course
faster than you think.

Operational in 30 days or less
Cutting Edge Technology
HIPAA Compliant