Brokers - ClaimDOC, LLC

Why ClaimDOC?

We help brokers win business. By opening up exciting alternatives, you can offer clients solutions beyond traditional carrier alternatives. You’ll be in a better position than ever to gain the trust of organizations and capture their business. Get ahead of the curve, and add ClaimDOC to your tool belt.

ClaimDOC offers brokers a creative, consultative solution to re-energize clients and win new business. Learn what sets us apart in the reference based pricing market that has been flooded with low-cost and poor-quality alternatives. Get ahead of the curve and create a rich and sustainable healthcare plan with ClaimDOC.

What Sets Us Apart

ClaimDOC Versus Traditional Network Solutions

25 to 35% Typical Cost Savings
Richer Benefits For Members

ClaimDOC Versus RBP Vendors

Dedicated Client Onboarding Team

Focused and holding your client’s hand during transition

Superior Member Advocacy

Dedicated employees driven to take care of plan members

Pave The Way®

Educating members’ providers to create the optimal outcome

Line-by-line Claim Auditing

Licensed healthcare professionals uncovering errors that basic repricing doesn’t catch

Litigation Defense

Bearing full cost and management of plan and member legal disputes

Dedicated Balance Bill Support Program

Relieves members obligation to engage in payment disputes with providers on ALL claims

Full Accountability

Always there for the plan in hard times

Working With Us

Long-Term Loyalty

Although plan sponsors may buy RBP based on savings, they truly expect a comprehensive replacement solution. With ClaimDOC, there are no surprise upcharges for services they discover are needed for success. Our full set of services is always made available, and we believe critical to make RBP a sustainable alternative. Without them, plans will struggle with member challenges or succumb to unforeseen expense that dilutes savings.

Superior Risk Management

Managing a successful RBP relationship involves exposures that need to be planned for and managed. From understanding the impact of settlements to proper policy structure, we make the tough calls. Our program was designed to completely take care of brokers and their clients who put their trust in us.

Protecting Your Revenue

ClaimDOC works with consultants to ensure their fees and commissions are net positive when switching to our program. We understand achieving massive savings for clients often involves extra work for you. We believe consultants should be fairly compensated for helping clients do the right thing.

Fee Structure

ClaimDOC utilizes a claims-based fee structure that supports superior service and risk transfer allowing us to expertly act as fiduciary to the plan. Our fees are the most straight forward in the industry. No upcharges for select services which will inevitably be needed. No commingling of PEPM and claims-based payments within the same contract. Relative to claims-based competitors we have the lowest rates and the most comprehensive use of fee caps. We understand PEPM is the more comfortable fee structure and it’s easier to sell a cheap vendor. Our broker partners know we deliver the lowest Per Employee Per Year NET Medical Spend in the industry and get past the spreadsheet mentality. Contact us to learn more.

What Is Reference Based Pricing?

Reference based pricing (RBP) is a generic term used to describe a type of medical claim pricing utilized by self-insured medical plans. Traditional programs rely on a carrier or network with provider contracts. Those contracts define a discount based off billed charges (the chargemaster). The billed charge becomes the reference point for calculation and the reference point changes from hospital to hospital without consistency or regulation. The lack of reference point consistency, along with outlier provisions, makes it impossible to understand the value of the discount or know the cost of services. RBP simply looks to define a more consistent reference point, with Medicare rates being most commonly used, due to its quantifiable and widely acceptable industry-recognized standards. Plans then apply a premium above Medicare and make payment to the provider based on that markup. More sophisticated vendors, like ClaimDOC, utilize audits and multi-factored data to determine facility-specific payments.

The principle of using a consistent reference point is what defines RBP and what drives savings to the plan sponsor. RBP does not define the level of quality and services each vendor provides, making services evaluation the most critical aspect to vendor selection.