The DOC

October 2025 | Get the latest from the best RBP advocates and auditors 

Industry Perspectives

Omar Arif

Senior Vice President of Growth

Shutting Down New Sales

It’s bittersweet for me as the senior vice president of growth to announce ClaimDOC is shutting down new sales for the year. We are selectively limiting new sales to exception only until April 1, 2026. We are just hitting the hot sales season for mid-market self-funded groups, and it’s difficult to tactfully and humbly communicate to brokers the message, “We will pass on this opportunity.” We've worked on building relationships with some of these brokers for years, and it doesn't feel good to have to turn them away. I can’t believe I’m saying this as the person responsible for leading our sales, but I was part of the decision-making process and it’s the right call. Read more.

ClaimTalk

Vetting Your Vendors’

Cyber Vulnerability

If your organization sponsors a self-funded health plan and cybersecurity isn’t part of your vendor evaluation criteria, it’s time to reassess. Protecting your own infrastructure is essential, but it’s not enough. Every vendor with access to your data must meet rigorous cybersecurity standards. Otherwise, you’re not just accepting risk, you’re creating it.

In this episode of ClaimTalk, Andrew Smith and Jeremy Schuller share with Danielle Young some of the threat tactics that cybercriminals are using today and discuss best practices in evaluating vendors to ensure your data will be secure.

Subscribe now so you never miss an episode:

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Audit Spotlight

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

Senior Audit Manager

Billing Errors on Healthcare Claims: Fraud or Abuse?

In the context of medical coding, fraud involves intentional misrepresentation of services billed. Abuse refers to the falsification of information that was likely an innocent mistake but nonetheless representative.

In this Audit Spotlight, we focus on medical billing and coding errors made on healthcare claims, and a question that is frequently deliberated: does the error fall into the category of fraud or abuse? 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.

Tulsa, Oklahoma

Six-day hospital stay for the treatment of second-degree burn, corrosion of left foot and related surgery

Traditional Network Plan

• Hospital Bill: $108,708.07
• Median Commercially Contracted Price
  • $38,249.29

• Patient Responsibility 20% Coinsurance:
  •  $7,649.86

DirectAccess+

• Hospital Bill: $108,708.07
• ClaimDOC Allowable
  • $22,132.49

• Patient Responsibility 20% Coinsurance:
  • $4,426.50

• Plan Savings: $16,116.80
• Member Savings: $3,223.36

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

"Amanda is amazing! I am a newly single dad and I'm struggling with getting my daughter signed up and to the appointments she needs. Amanda literally took care of everything except driving us there, and she did it in the fastest, friendliest way possible."

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