ClaimDOC 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. Simply put, RBP works to lower the high costs of healthcare. Traditional programs rely on a carrier or network with provider contracts. 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 defines a consistent reference point, with Medicare rates being the most commonly used.