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.
JUL 2020 | Get the latest from the best RBP advocates and auditors
Industry Perspective
Ben Krambeck
CEO/Founder
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. Aside from the confusion created at the member level as to whether they have a network, we are seeing trends making utilization of physician-only networks challenging. The best course of action in this evolving space is to eliminate both the facility networks and the physician network and leverage a comprehensive RBP program for total network replacement.
Physician-only networks and ancillary facility networks were appealing to the early adopters of RBP going back a decade ago. Providing a safety net for brokers and the plan sponsor was necessary to drive business because of the unknowns associated with the novel approach. These were viable backbones to solve access concerns on low-dollar claims in the early years. Unfortunately, we have watched the systematic dismantling of physician-only networks and ancillary facility networks as they are purchased by the major managed-care organizations and shut down almost immediately. This has put holes in the safety net. Read more..
Client Savings
Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.
Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.
Member Experience
Feedback from a Member
I wanted to take the time to contact you regarding one of your employees, Brittany Smith, in the ClaimDOC call center. Last Friday I was calling in with some questions/concerns regarding a few bills I received and accidentally went to ClaimDOC instead of Member Benefits.
Brittany listened to my issue and not only was sympathetic but pleasant to talk to. She advised me that I needed to talk to Member Benefits and was more than glad to transfer me. She took down my contact information in the case we were disconnected in the process. During the process, we were disconnected (my fault). Brittany took it upon herself to not only talk to member benefits to help me resolve my issue but called me back with a resolution and advised she would follow up with me today to give an update on the issue. I was more than pleased with the customer service I received from Brittany and feel she went ABOVE AND BEYOND for me.
I wanted to ensure I recognized her for her hard work and dedication. It’s not often in Customer Service that we get positive feedback and wanted to shine the light on some positivity.
Thank you very much!
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