Our in-house out-of-network repricing service is fully integrated with our self-funded solution.
Even with the best plan language in place, out-of-network (OON) claims happen. On the high end those claims can make up 15% of your total claim spend and those dollars can add up. Concerned? Keep reading.
Unlike most TPAs and carriers that vendor out their OON repricing, our service is fully integrated with our self-funded solution. What does this mean for you? With the right plan language in place, we’ve helped our clients save up to 60% on OON claims, compared to 25% with other PPO repricers.
Here’s a look at the benefits of our in-house repricing service:
- More efficient claims processing.
- Better claim status transparency.
- Claims are reviewed, researched and repriced by our team of reimbursement specialists (we’ll never put you on auto-pilot).
- Alongside your plan language, we leverage our own methodologies, industry baselines and market insights to negotiate and reprice claims at the best possible price for you.
- Post-payment support including appeals response and dispute resolution.
Repricing Insights is run on Pricegauge™, our proprietary repricing platform, that helps us examine the unique state of a local market and providers’ billing practices. This enables us to leverage marketing data, industry standards and our proprietary methodologies to get you the best savings possible.