Same Colonoscopy, Different Facilities, Wildly Different Costs
More than 16 million colonoscopies are performed in the United States each year. A common gastrointestinal procedure, colonoscopies are routinely performed as a screening for…
Resources
Good TPAs – They Do Exist
Who’s a good third-party administrator? There are many to choose from, but far fewer that consistently deliver when it matters. And the difference between…
Member Saves $10K After Complicated Childbirth
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…
Looking Back and Looking Forward
Review of 2025 I really look forward to writing this article each year. Who you trust your health plan with is a huge decision, and…
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…
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…