The Search for a Good TPA — Part 2
Selecting the right vendors for a reference-based pricing health plan isn’t an exact science. At the end of the day, it often comes down…
Resources
Member Saves Over $23K While Audit Reduces Plan Cost by Nearly $117K
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
Burden of Healthcare Fraud and Abuse Impacts Everyone
Program integrity strategies focus on pricing and reimbursing the correct amount to legitimate providers and suppliers for covered services — reasonable and necessary services provided…
Contracting Strategy Proves Successful in 2025
In my role leading provider relations, I have many conversations with prospects, clients and brokers regarding our contracting strategy. Our strategy is unique in the…
Claim Audit Delivers $48,336.27 in Plan Savings
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
Outrageous Anesthesia Charges Raise Questions
As healthcare costs continue to climb an upward slope, there is an escalated and ongoing need for closer assessment of healthcare claims to assist in…
The Search for a Good TPA — Part 1
Building a successful self-funded health plan demands skilled and efficient vendor partners that have the expertise to deliver on their promises. Identifying the best…
4 Must-Do’s for Nailing RBP Open Enrollment
Open enrollment season is a bustling time of year, especially for groups going live on Jan. 1. Not only are people prepping for holiday feasts,…
Audit Saves Plan $18,412.58 After Member’s Hospital Stay
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…