Apr 19, 2021

No Surprises Act

In a bipartisan effort to end balance billing, the No Surprises Act was written into the most recent coronavirus relief package. “Balance bills” are bills…

Mar 12, 2021

6 Questions About Making the Switch to Reference Based Pricing

Healthcare costs continue to increase annually at a rate far above the national cost of living percentage. Health insurance is one of the largest expenses…

Feb 16, 2021

My Journey From BUCA to ClaimDOC

The US healthcare system provides an undeniable quality of care, technology, and providers. Yet, these providers are disconnected from the member by a maze of…

Dec 16, 2020

Looking Back and Going Forward

As we look back at 2020 from a business perspective, it’s almost mind-numbing to summarize the meaningful events that unfolded. Ultimately, I’m so proud that…

Nov 3, 2020

COVID-19 billing observations and information

We released an Audit Spotlight in our last newsletter related to a COVID-19 claim. The claim example generated many questions from the brokers…

Sep 29, 2020

Member Education, the key to a successful RBP program

Education is the basis of a successful health benefits experience, especially when it comes to reference-based pricing (RBP). Creating a robust year-round education program that…

Sep 2, 2020

Renewal season is upon us

If you think you will flatten renewals this year, you should reconsider. While it is true COVID-19 held utilization down to levels unseen for almost…

Aug 7, 2020

New price transparency regulations

Healthcare-related costs continue to soar. The number of patients who are surprised when they receive an astronomical bill for a covered service is also growing…

Jul 9, 2020

Full Network Replacement

Traditional program structure for reference-based pricing has included a physician-only network coupled with a vendor capable of auditing and applying revised pricing to facility claims.