PBMs: Are You Getting Good Advice? – Part 1
Unbundling health plans can be rewarding for both employers and their employees, but it’s no secret that it comes with a unique set of…
Resources
Egregious Charges, Price Transparency and Pricing Tools
In this month’s Audit Spotlight, we focus on a claim example where our audit team zoomed in closer on the billed services and related charges.
Audit of Hospital Stay and Surgery Saves Member $10,391.10
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…
RBP From the Front Lines: When the ‘Easy’ Plan Isn’t Member-Friendly
BUCAs may seem like the easy, all-inclusive choice, but they don’t offer the personal, one-on-one assistance most health plan members actually prefer. Plus, no…
New Codes, Guidelines, Medical Billing Considerations in 2025
The complexities surrounding medical coding, billing and submitting an accurate claim the first time is a given. Anyone in the business of healthcare will attest…
Audit of 5-Day Hospital Stay Results in $2,730.01 in Member 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…
ADVISORS UNLEASHED – Part 2
This month’s episode of ClaimTalk is the second half of a discussion with brokers and industry experts Craig Gottwals and Mike Kerns.
The Importance of Thoroughly Reviewing Medical Bills
A single visit to a hospital emergency room or the hospital outpatient department can result in a complex array of medical bills covering several services…
What to Pay Your Broker
Whether it is LinkedIn or conferences, we are inundated with conversations bashing benefits brokers. I wanted to take an opportunity to flip that around and…