Our auditing processes and multi-level methodology review both Medicare and the facility’s cost of service to create a fair and reasonable payment from the outset. Other reference based pricing companies often wind up entering “settlement mode” as they negotiate with the provider against their own recommendations. The results of this typically resemble a preferred provider organization reimbursement, and the client and carrier are stuck paying the bill—many times after the close of the policy period.
What To Expect With ClaimDOC
- No surprises. When the plan year is over, the claim experience is the claim experience. ClaimDOC doesn’t begin settlements of outstanding balance bills expecting the carrier to jump in and save the day.
- Unparalleled underwriting reliability. Our carrier partners regularly praise ClaimDOC’s ability to manage claim experience and high cost claimants, all while providing protection from legal exposure. Our clients’ net medical spending is consistently on target.
- Low loss ratios. ClaimDOC’s hands-on claims management continually provides best-of-breed loss ratios for our carrier partners. Our clients are consistently profitable.
Protected By Fee Caps
ClaimDOC’s fees are claims-based, however, our fees are only charged for claims in which we audit (facility and high-dollar professional). We also cap our fees to ensure our clients and carriers aren’t exposed to unlimited costs associated with inflated billing.
Our clients expect and deserve consistency. We help them achieve steady stop-loss renewals, which leads to satisfied customers and long term relationships.