The DOC

January 2026 | Get the latest from the best RBP advocates and auditors 

Industry Perspectives

Brad Hansen

Vice President of Provider Relations

Contracting Strategy Proves Successful in 2025

In my role leading provider relations, I have many conversations with prospects, clients and brokers regarding our contracting strategy. Our strategy is unique in the industry and one you’ll only find with ClaimDOC. This is not a one-size-fits-all or factory approach you tend to see in the reference-based pricing space. Our thoughtful approach does require stakeholders to trust our process, which can be more uncomfortable than us committing to strategies that sound good in a sales presentation but leave savings on the table. Due to this dynamic, I’ve been asked to share insights into what this looks and feels like for clients, based on actual 2025 results. Read more.

ClaimTalk

The Search for a Good TPA – Part 1

Building a successful self-funded health plan demands skilled and efficient vendor partners that have the expertise to deliver on their promises. Identifying the best vendors can be challenging, and settling for substandard partners can lead to less-than-desirable outcomes. But how do you find the best partners?

On this episode of ClaimTalk, Emma Fox gets brutally honest during the first half of a two-part conversation with Danielle Young, Bruce Hansen and Stephanie Mohr on the struggles that can arise with vendors. While a good portion of the discussion centers on the issues they’ve experienced with third-party administrators, they also discuss why it can be difficult to find the right partners, the strategies they use to identify dependable vendors, and why some of the most unreliable vendors continue to survive in the industry.

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Audit Spotlight

Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA

Senior Audit Manager

Outrageous Anesthesia Charges Raise Questions

As healthcare costs continue to climb an upward slope, there is an escalated and ongoing need for closer assessment of healthcare claims to assist in identifying egregious charges, improper medical billing errors and associated improper claim payments.

In this Audit Spotlight, we focus on the varying charges for anesthesia services being reported and billed on the CMS-1500 claim form, or electronic equivalent, and what that means when the calculation of charges is broken down based on a per-minute charge and a per-hour charge basis. Read more.

DirectAccess+^® Savings

DirectAccess+^® clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. Our audit team performs line-by-line claim audits to help clients and members maximize their savings. Below is one recent audit result showcasing substantial savings.

Savannah, Georgia

Ten-day hospital stay for the treatment of morbid obesity, and respiratory and kidney failure.

Traditional Network Plan

• Hospital Bill: $245,790
• Median Commercially Contracted Price
  • $97,312

• Patient Responsibility 30% Coinsurance:
  •  $29,193.60

DirectAccess+

• Hospital Bill: $245,790
• ClaimDOC Allowable
  • $48,975.73

• Patient Responsibility 30% Coinsurance:
  • $14,692.72

• Plan Savings: $48,336.27
• Member Savings: $14,500.88

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

"Beatriz provided me plenty of options when trying to find a provider in my area and quickly helped me schedule my appointment. A task I'd been putting off for months, she made happen in a day. Having her support in taking care of my health is so meaningful to me. Thank you, Beatriz!"

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