Sometimes you just have to turn on some classic rock to get your mind right. I’m not sure how much Styx knew or cared about medical benefits, and ”The Best of Times” might have been a pseudo love song, but it hits the spot for us at this moment.
August 2025 | Get the latest from the best RBP advocates and auditors
Industry Perspectives
Bruce Hansen
Executive Vice President
Midyear Business Update —
The Best of Times
Sometimes you just have to turn on some classic rock to get your mind right. I’m not sure how much Styx knew or cared about medical benefits, and ”The Best of Times” might have been a pseudo love song, but it hits the spot for us at this moment.
Our entire staff focuses on problems and spends each day grinding out the best possible solutions. Our clients and their brokers are also making a choice to do something that’s more complex and requires more work than a network solution. Taking on the challenge of unaffordable healthcare and the systemic pressure to just fall in line is hard, but you have to step back and appreciate what is being accomplished. The current level of intense interest in RBP up against those desperately trying to suppress its adoption has created a unique dynamic, making this such an incredible time to be in the cost containment space. It really is the best of times for ClaimDOC. Read more.
ClaimTalk
Adapt or Fall Behind: Making Nontraditional Plans Thrive
For nontraditional health plans to work — whether they use reference-based pricing or another strategy — they often require customized solutions. As health plans evolve, vendors can’t ignore new methods to give plan members what they need.
In this episode of ClaimTalk, Amy Pellegrin and Stephanie Mohr visit with Sharla Mallett, a member of our direct primary care team. They discuss how the DPC team works to give members a more personalized health plan experience and why making adjustments to health plans is crucial to providing a positive member experience.
Why the Variation of Physician Fees for the Same Medical Service?
Let us zero in on a service many physicians bill: CPT code 99291. Defined as “critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes,” the American Medical Association CPT codebook outlines specific rules and guidelines from the AMA’s CPT editorial panel regarding the use, reporting and billing of this code. It is key that physicians understand these guidelines to help ensure compliant coding and billing of critical care services.
In this Audit Spotlight, we focus on the wide variation of physician fees for the same medical service. 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. The 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.
Chicago, Illinois
Six-day hospital stay for the treatment of aortic aneurysm with related surgery
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 Broker
"We are new to the RBP model, so I have had A LOT of questions. Leah's communication and responsiveness is fantastic. She answers the phone if I have questions and, if she doesn’t know the answer, at least knows where to get an answer."
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