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Navigating the Complexities of Healthcare Advocacy: A Five-Year Partnership with ClaimsBridge

Christine Cooper of Aequum Shares Insights on Legal Advocacy, the Impact of the No Surprises Act, and Success Stories in Collaboration with ClaimsBridge

Read time: @ 7 minutes

When did Aequum begin its partnership with Client’s Bridge?

Christine Cooper

We’ve been working together for more than five years now, I believe. It arose out of another relationship and really grew from there.

We got to know each other, got to know Mike, got to know Kevin, and ultimately, because of the work that ClaimsBridge does and the work that we do, we fit together very well as partners.

What are the main services that you provide to ClaimsBridge clients?

Christine Cooper

We provide legal advocacy services, patient advocacy services. We defend balance bills for any plan participants who go to a provider and receive an egregious bill.

We have a partnership with Koehler Fitzgerald, which is a national law firm. We have attorneys there that are defending these bills, but we also have a robust customer service team that is building relationships with the plan participants that ClaimsBridge refers to aequum.

Now that there’s the No Surprise Act, we are also providing services directly to the plans to assist with defending the IDR (independent dispute resolution) claims.

Why do you like working with ClaimsBridge?

Christine Cooper

We love working with them. I think everyone on the ClaimsBridge team is great. Our organizations are aligned in our goals and our mission, reducing health care costs and bringing innovative health care plans to self-funded employers to help attract and retain employees, but also getting good health care plans to the employees themselves.

The ClaimsBridge team is very responsive. I think we’ve just built a really good relationship over the past five years.

There’s the good work that ClaimsBridge is doing as far as doing the repricing and the direct networks that truly help the patients whom we are ultimately on the tail end working with.

It’s just it’s been a very healthy relationship.

Thinking about the totality of the services that you provide, what would you say is the gap in health care that you’re addressing and has that shifted in the last few years?

Christine Cooper

The gap that we’re addressing is advocating for and defending patients when they get excessive medical bills. They get scared and they don’t know what to do with them.

They go to collections and that’s very intimidating for many people. More specifically, we’re alleviating the stress that those plan participants have arising out of any balance bills, or large bills that they’re receiving, any out of network bills, things of that nature.

At aequum, we step in and provide legal representation to the member. The providers then communicate directly with us. The collection agencies correspond with us. And in turn, we have our customer service team that’s communicating with the plan participants. So lifting the burden off the plan participant is one of the gaps that we’re filling.

We also help the employer in their HR function because now you have plan participants that are coming to us instead of taking up time with the HR team.

I would say those are the two primary gaps we address. The other thing is relative to the No Surprises Act. We bring some clarity to the plans so that they know how to respond and we make sure that they’re in compliance with any of the NSA requirements.

And taking the burden off their plate, for both the TPA’s and the plans themselves, we’re handling the open negotiation notices or putting together the packets of information that go into the notice of offer for the actual arbitrations.

How have you seen the impact of the No Surprises Act play out for health plan providers and TPA’s?

Christine Cooper

Right now, the No Surprises Act is still very much a mess and I think there’s a lot of confusion.

The timelines have been constantly moving, the expectations have been constantly moving, so it’s difficult for a TPA or a plan to stay on top of all that.

This is a shift for the plans that Claimsbridge and aequum are working with.

The first issue is whether these claims are even eligible for the process because these providers are putting so much through that really doesn’t even belong in the process to start with.

The second question is: “gee were things paid properly?” So, the problem is overuse of the process by the providers instead of going through the channels that they really should be going through – for reference-based pricing plans that would be balance billing the member (which allows for a strong defense against the unreasonable bill)

And the IDR entities, those arbitrators that are selecting who’s winning and who’s losing are so overworked that from their perspective, I can’t imagine what it’s like to wade through these claims.

You’re getting a lot of inaccurate results and challenging results. The interesting thing, though, is there’s absolutely no enforcement provision and there’s some litigation out there about this right now.

It’s the wild, wild west, and I don’t think we know how this is going to shake out. And I don’t think we’re going to know how this is going to shake out for quite some time. But, from a claim eligibility standpoint, what we’re seeing is claims being dumped into that process and claims that we’re handling or that ClaimsBridge is referring to us, dumped into that process that have no business being there. As a result, one of the things that we’re frequently doing is challenging the eligibility of those claims.

Tell us about a success story that you’ve had for a ClaimsBridge customer.

Christine Cooper

Most recently we received a full write-off for one of the plan participants. The bill was about $4,000. Ultimately, both the plan and plan participant save and such success increase plan participant buy-in on this more innovative plan structure.

Any time we’re getting a full write-off, which we’re seeing more and more, that’s a big success, no matter the size of the bill.

The other is of the claims that we’ve handled for the IDR process that have resulted in a decision, we’ve had seven claims that were deemed ineligible, and that’s the very first argument we make in the process. Getting those claims timely kicked is a success under the No Surprises Act.

Anything else that you’d like to add?

Christine Cooper

I think that just the one thing that I would add is ClaimsBridge has been very attentive to the changes in in the healthcare environment.

I’ve really enjoyed working with Kevin and Mike and others on the team and staying on top of and ahead of those healthcare issues we’ve been discussing. And our partnership has been fabulous in addressing a lot of these health care issues that are ongoing.

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2024-09-13T14:28:21-04:00September 13, 2024|

ClaimsBridge Ranks No. 2557 on the 2024 Inc. 5000

With Three-Year Revenue Growth of 201% Percent, ClaimsBridge Ranks No. 2557 Among America’s Fastest-Growing Private Companies

Arnold, MD, August 13, 2024Inc. revealed today that ClaimsBridge ranks No. 2557 on the 2024 Inc. 5000, its annual list of the fastest-growing private companies in America. The prestigious ranking provides a data-driven look at the most successful companies within the economy’s most dynamic segment—its independent, entrepreneurial businesses. Microsoft, Meta, Chobani, Under Armour, Timberland, Oracle, Patagonia, and many other household-name brands gained their first national exposure as honorees on the Inc. 5000.

“Being recognized as part of the Inc. 5000 is an incredible honor and a testament to the hard work and dedication of our entire team at ClaimsBridge. This achievement reflects our commitment to innovation, excellence, and delivering outstanding value to our clients. We strive to reduce unnecessary costs in healthcare administration, our growth shows that our solutions are delivering real results for our clients,” says Kevin Gibson, CEO of ClaimsBridge.

The Inc. 5000 class of 2024 represents companies that have driven rapid revenue growth while navigating inflationary pressure, the rising costs of capital, and seemingly intractable hiring challenges. Among this year’s top 500 companies, the average median three-year revenue growth rate is 1,637 percent. In all, this year’s Inc. 5000 companies have added 874,458 jobs to the economy over the past three years.

For complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, location, and other criteria, go to www.inc.com/inc5000. All 5000 companies are featured on Inc.com starting Tuesday, August 13, and the top 500 appear in the new issue of Inc. magazine, available on newsstands beginning Tuesday, August 20.

“One of the greatest joys of my job is going through the Inc. 5000 list,” says Mike Hofman, who recently joined Inc. as editor-in-chief. “To see all of the intriguing and surprising ways that companies are transforming sectors, from health care and AI to apparel and pet food, is fascinating for me as a journalist and storyteller. Congratulations to this year’s honorees, as well, for growing their businesses fast despite the economic disruption we all faced over the past three years, from supply chain woes to inflation to changes in the workforce.”

ClaimsBridge is proud to have earned the loyalty of clients who have relied on our services for over 20 years, a testament to our client-focused support and service. Our recent transformation has expanded our product offerings, network access, and team to better serve our growing client base. This past year, we migrated to the cloud, obtained SOC Level II certification, and were honored as one of the Inc. 5000 top growth businesses in the U.S. While we celebrate these achievements, our primary focus remains on enhancing the client experience, with new hires and upcoming tools designed to improve support, streamline processes, and ensure we effectively drive down the cost of healthcare administration.

CONTACT:

Kevin Gibson

Claims Bridge – Chief Executive Officer

Tel: (201) 952-6934

Email: kgibson@claimsbridge.com

www.claimsbridge.com

More about Inc. and the Inc. 5000

Methodology

Companies on the 2024 Inc. 5000 are ranked according to percentage revenue growth from 2020 to 2023. To qualify, companies must have been founded and generating revenue by March 31, 2020. They must be U.S.-based, privately held, for-profit, and independent—not subsidiaries or divisions of other companies—as of December 31, 2023. (Since then, some on the list may have gone public or been acquired.) The minimum revenue required for 2020 is $100,000; the minimum for 2023 is $2 million. As always, Inc. reserves the right to decline applicants for subjective reasons. Growth rates used to determine company rankings were calculated to four decimal places.

About Inc.

Inc. Business Media is the leading multimedia brand for entrepreneurs. Through its journalism, Inc. aims to inform, educate, and elevate the profile of our community: the risk-takers, the innovators, and the ultra-driven go-getters who are creating our future. Inc.’s award-winning work achieves a monthly brand footprint of more than 40 million across a variety of channels, including events, print, digital, video, podcasts, newsletters, and social media. Its proprietary Inc. 5000 list, produced every year since its launch as the Inc. 100 in 1982, analyzes company data to rank the fastest-growing privately held businesses in the United States. The recognition that comes with inclusion on this and other prestigious Inc. lists, such as Female Founders and Power Partners, gives the founders of top businesses the opportunity to engage with an exclusive community of their peers, and credibility that helps them drive sales and recruit talent. For more information, visit www.inc.com.

For more information on the Inc. 5000 Conference & Gala, to be held from October 16 to 18 in Palm Desert, California, please visit http://conference.inc.com/.

About ClaimsBridge

ClaimsBridge is a healthcare technology company providing custom and high-performing networks, direct-to-employer contracting, RBP and Medicare pricing solutions (ClaimsBridge Navigator), and unified end-to-end pre-adjudication infrastructure for the receipt, routing and pricing of medical claims (ClaimsBridge Connect). ClaimsBridge is directly connected to over 120 partners serving self-funded and fully insured employers through their broker and benefit consultants, stop-loss carriers, third-party administrators, healthcare networks, and strategic vendor partners.  For more information about ClaimsBridge service offerings, visit www.claimsbridge.com or call 410.349.3222.

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2024-08-14T17:12:44-04:00August 14, 2024|

Meet the Team! – Melissa Barrios

Employee Spotlight: Melissa Barrios: Longevity and Loyalty in a Supportive Culture

At ClaimsBridge, we pride ourselves on our close-knit community and the dedication of our team members. Today, we’re shining a spotlight on one of our long-time employees, Melissa Barrios, who has been instrumental in our growth and success. Melissa has held many roles during her time at ClaimsBridge and is currently HR Administrator. Melissa has been with ClaimsBridge for over 16 years

What initially attracted you to join our company, and what has made you stay?

The opportunity for growth! 16 years later I feel as though I am a testament to the great opportunity for growth within our company. The evolution of our company is what has attracted me to stay. There has been continuous growth and change for the good. It has been very cool to see where we started to where we are now and have had the honor to be here for the journey.

How would you describe the work-life balance at our company? What support or resources have you received to help maintain that balance?

Understanding and accommodating is how I would best describe it. We all understand our roles, responsibilities, and dedication to a successful and productive work week, but we are all very aligned when it comes to the importance of family life and employees’ lives outside of the office. I had my first child in 2020 and I was able to work out a slight change in work hours and a hybrid work schedule with our leadership team. This was beneficial not only for the timeliness of pick up and drop off schedule, but also because the time I would have usually been traveling on my commute, could now be spent with my family. More recently with the collapse of the Key Bridge, a few employees were affected by their commute, including myself. Taking into account the much longer commute, my in-office hours were quickly adjusted.

” Our company has dedicated time and resources to not only making sure our work environment is a place where we feel comfortable, but a place where we are inspired to grow along with it.”

Can you describe your most significant achievement or project during your time at the company and how it impacted the organization?

It is hard to pick one, but the revamp of our contract was not only an achievement but also probably my favorite project. I was assigned the task of restructuring our Master Services Agreement back in 2022. Prior to this, our contract was 4-5 separate documents which all needed to be reviewed and signed off on by each new prospect. I redesigned the document and consolidated all the legal language as well as product pricing into one single document. This not only made the sales process more seamless and efficient, but it also helped the finance department easily identify and build the items for billing.

How has your role evolved since you joined the company, and what steps have you taken to adapt to those changes?

I started out working in our mailroom. Opening claims, answering customer support calls, and day to day tasks like filing and shredding. During my time at ClaimsBridge I have gained a wealth of knowledge about the company and every aspect of each department. With that type of knowledge and tenure, I’ve been deemed the title of Swiss Army Knife. Easily being able to jump in to act as a liaison for finance, sales, operations, and even back to my roots, the mailroom. In my latest role as HR Administrator, I’ve taken advantage of our employee education reimbursement policy and enrolled in the Society of Human Resources Management course in hopes to gain my SHRM-CP this summer.

How do you think our company’s culture and values impact the way we work and make decisions?

Our company has dedicated time and resources to not only making sure our work environment is a place where we feel comfortable, but a place where we are inspired to grow along with it. We involve employees in big decisions. Genuinely taking into consideration their thoughts and ideas.

Anything else you’d like to share?

If you would have asked me at the age of 18 when I first started working for this company, where I thought I would be now…I never would have thought I would be here. In a position where I work with wonderful people, who work so hard and well together as a team, and have a career that I am very proud of and love.

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2024-05-13T11:52:08-04:00June 3, 2024|

The Link: Inaugural Issue

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2024-05-16T14:33:10-04:00May 16, 2024|

Celebrating ClaimsBridge’s Achievement of SOC 2 Compliance Certification

A Commitment to Enhanced Trust and Security

We are excited to announce that ClaimsBridge has successfully achieved SOC 2 compliance certification, marking a significant step in our commitment to the security, privacy, and integrity of our clients’ data.

Kevin Gibson, CEO of ClaimsBridge, emphasized the importance of this certification: “Achieving SOC 2 certification is not just a milestone—it’s a testament to our dedication to the highest standards of data security and privacy for our customers. We recognize the importance of protecting sensitive information, and this achievement solidifies the trust our customers place in us.”

In the face of increasingly sophisticated cyber threats, particularly within the healthcare industry, ClaimsBridge has taken proactive steps to ensure robust cybersecurity measures are in place. The SOC 2 compliance confirms that ClaimsBridge adheres to rigorous security protocols necessary to protect healthcare data from unauthorized access and breaches.

Jason Werner, Chief Information Officer, highlighted the technical excellence behind this achievement: “Our engineering team has worked diligently to implement comprehensive security measures. SOC 2 certification reassures our customers that we provide a secure and trusted platform for healthcare claims management, maintaining data privacy, confidentiality, and availability at every operational level.”

SOC 2 compliance involves strict adherence to established security and operational criteria, including the management of data security, availability, processing integrity, confidentiality, and privacy. This certification demonstrates that ClaimsBridge has robust policies and procedures to effectively safeguard sensitive information.

This certification reaffirms that our longstanding practices and procedures have consistently aligned with key regulatory standards such as HIPAA, ensuring that we manage data according to industry best practices and legal requirements.

The journey to achieving SOC 2 compliance involved meticulous planning, continuous monitoring, and improvement of our processes. Simon Cooper, IT Development Manager, noted, “This certification involved comprehensive planning and ongoing enhancement of our internal controls to meet the stringent standards required to protect customer information.”

For more information about our SOC 2 compliance or our services, please contact us today. We are here to assist you in navigating the complex landscape of data security with confidence and integrity.

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2024-04-26T09:40:17-04:00April 26, 2024|

Meet the Team! – Simon Cooper

Employee Spotlight: Simon Cooper: Start Up Agility in a Family Environment

At ClaimsBridge, we pride ourselves on our close-knit community and the dedication of our team members. Today, we’re shining a spotlight on one of our newest employees, Simon Cooper, who is leading some important initiatives for our team and our clients. Simon is our Healthcare IT Development Manager at ClaimsBridge.  He brings over 20 years of passion for creating and delivering innovative SaaS products that solve customer problems and drive revenue growth and puts that to work for clients and team members alike.

Q: What initially attracted you to join ClaimsBridge and what has made you stay?

Several things. From my point of view, I wanted to join a growing company that was doing something interesting in technology, would be a good fit for my experience, and a more technical, hands-on role

But I also wanted it to be very specific to my location. Having commuted around the Washington DC beltway for 10 years I knew I didn’t want to do that again. And then having worked at home fully remote for several years, I realized it’d be nice to go into an office every once in a while, rather than being fully remote.

I was kind of looking for something that was blended, that had all those attributes.

The Healthcare IT Development Manager role popped up at ClaimsBridge and it seemed it was a good fit.

When I came in to interview and had time to speak with Jason and Kevin and really learn more about the role, the company, and the culture, it became really apparent to me that this would be a great fit and it was exactly what I was looking for.

I could also see that it was going to be a very interesting role. It’s a small company with that start up feel even though they’ve been in business for 20 years. ClaimsBridge has got that on the cusp of great things feeling and you can see the growth potential. You can see how the business and technology is evolving.

These are all things I’m interested in and love getting involved with those kinds of challenges, solving the problems of a smaller company trying to grow and become a larger enterprise player.

Q: How would you describe the work-life balance at Claims Bridge?

I would say ClaimsBridge definitely sees balance as a very important aspect of life. They’re very respectful and supportive of work-life balance.

There’s a real culture of not disturbing people when they’re on vacation, not creating deadline stress, and checking that workloads are manageable. I’ve worked previously at companies where you were expected to be available almost 24-7, working across multiple time zones and countries. It’s just go-go-go all the time. This is much more relaxed, and straightforward.

Of course, there are deadlines to meet and there are urgent priorities to tackle, but we’ve got time to do it, and time to plan not just react.

Q: Are there any specific support or resources that you’ve received help with to help you specifically maintain balance?

I think it’s just the overall support from the leadership team, they’ve clearly set out their expectations of how they want the company to work and how they want to support people in their roles. An open-door policy where you can discuss any challenges you have with your role, or work life balance with managers and leadership is excellent.

Q: Can you describe your most significant achievement or project so far and talk a little bit about how it’s impacted the organization?

Coming in as a new starter, half my time was trying to learn about the business, customers, and technology. The other half of my time was executing the SOC 2 compliance project, that I could really dig into and take ownership of.

Having completed all the items required for a SOC 2 compliance we completed our three-month audit period with the official third-party SOC 2 auditor going through all of our policies, procedures, standards and all of the evidence based data that we’ve put out in a data room for them.

We’ve received our SOC 2 compliance report and achieved certification. This will help the company prove to our existing customers as well as new potential prospects that we are a quality focused organization that securely manages our clients’ data and our software to the SOC 2 standards.

Q: How has your role evolved since you joined the company?

Given it is a fairly new role, it hasn’t evolved specifically since joining the company. However, the role has allowed me to work on a wide variety of projects.

Although, I’m responsible for the IT and the development team’s day to day operations, I’m also getting involved in other things to improve processes or tooling, such as implementing Azure DevOps to help manage the software development lifecycle.

Integrating that with our existing software platforms that we use here at ClaimsBridge to manage our client projects and product roadmap., I’m currently looking at not only how we enhance our security posture, by how we physically secure our resources, clients’ data and our locations to protect against those threats that are always present in the world of cybersecurity.

I get to work on these different varied projects, where one day it could be doing some software development and writing code. The next day it could be documenting processes or working on IT hardware. Variation keeps the job fresh and interesting day to day, week to week.

“It’s a small company with that start up feel even though they’ve been in business for 20 years.”

Q: How do you think ClaimsBridge’s culture and values impact the way the organization works and makes decisions?

I think the culture is very supportive of the individual.

Everyone’s respected. Everyone’s opinion is listened to. You really feel like you’re being heard as well. And there’s also a level of autonomy that they’ve built into the culture which frees people to go off and make decisions and get on with things.

We’re not bound by having lots of management structure and many layers of approval to get things done. We do have some specific approvals to help manage quality control and things like that, of course. But outside of that, we’re a pretty nimble organization. We can really turn things out quickly and move from one priority to another priority very easily.

Q: Is there anything else you’d like to share or anything that you would say to someone who’s thinking about coming to work at ClaimsBridge?

If you’re considering a job with ClaimsBridge, this is a great place to work. I think it really has the feel of a family-owned business and a startup, but it’s a 20+ year old company.

It truly feels like you’re joining the family. It’s a diverse group of individuals with lots of different experiences and backgrounds.

It’s also a really interesting place to work with new initiative and client projects happening all the time.

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2024-04-10T11:00:57-04:00April 10, 2024|

Meet the Team! – Jeffrey Penn

Jeffrey Penn, FAHM: Powering Growth

We recently had the opportunity to chat with Jeff Penn, Vice President of Business Development at ClaimsBridge, to uncover his unique journey with the company and explore what makes ClaimsBridge an exceptional place to work. Jeff’s story is one where freedom and growth is supported by the ClaimsBridge culture of collaboration and creativity from the bedrock of a thriving work environment.

Q: What initially attracted you to join our company, and what has made you stay?

It’s definitely the people; folks like Bob Schmidt, Mike Tosti. Mike was the real catalyst behind it all. We’ve worked together in the past and he’d had a great experience with ClaimsBridge. And the fact is their portfolio was attractive. It was clear that I had the ability to enhance it, which we’ve done. So those were the primary factors: simply relationships and product portfolio.

Q: Work-life balance is crucial. How would you describe it at ClaimsBridge?

We work from home, so it’s an ideal scenario.  I work constantly because that’s how I’m wired, but I can take breaks. I have a really nice set of trails right at the back door here, so if I want to go grab a quick 30-minute bike, I can do that.  It’s a mountain bike ride, so I get a good pump in 30 minutes and I come back energized for the rest of the day. Kevin Gibson as a CEO is very, very people-oriented, which is good and that’s a great culture to be in.

“The culture embraces ideas, assertiveness, and creativity. I’ve got the keys and I’m free to drive my ideas.”

Q: Can you describe your most significant achievement or project during your time at the company and how it impacted the organization?

It’s distribution and expansion of the product portfolio which encompasses our Connect Services, High Performance Networks, RBP platform and Blue Cross networks. We offer the most unique product portfolio in the industry which has enabled significant growth, and we are tracking to escalate revenues dramatically this year once again.

Q: How has your role evolved since you joined the company, and what steps have you taken to adapt to those changes?

I spearheaded efforts to increase our visibility in the TPA area and helped to enhance the product portfolio. We have seen dramatic revenue growth as a result.  Health systems sponsoring direct-to-employer initiative (D2E) and direct contracting by self-funded employers/TPAs is a trend and we have the ideal solution to ensure success for all parties. Our RBP platform is incredibly unique and has demonstrated substantial savings.

Q: How do you think our company’s culture and values impact the way we work and make decisions?

The culture embraces ideas, assertiveness and creativity. I’ve got the keys and I’m free to drive my ideas. It’s a positive culture, a great group of people in all departments, a warm atmosphere.

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2024-02-27T15:10:23-05:00February 27, 2024|

Enhanced Provider-Directory Search Function

🎉 Exciting News from ClaimsBridge! Explore our Enhanced Provider/Directory Search Function! 🌐

We’re thrilled to announce upgrades to the Provider/Directory Search function in our client portal. At ClaimsBridge, we understand the importance of a seamless user experience, and that’s why we’ve implemented a brand-new responsive design.

🚀 What’s New? Our enhanced design ensures a user-friendly and adaptive interface, making it easier than ever for our clients to navigate and find the information they need. Whether you’re searching for healthcare providers or exploring our networks, the updated design promises efficiency and a fresh, modern look.

🔍 Experience the Upgrade! Log in to our client portal and explore the enhanced Provider/Directory Search function. We believe this upgrade will elevate your user experience and streamline your interactions with ClaimsBridge Navigator.

🤝 Thank you for Trusting ClaimsBridge! We’re dedicated to innovation and excellence, and this upgrade is just one example of our commitment to providing top-notch services to our valued clients.

#ClaimsBridgeNavigator #HealthcareInnovation #ClientPortal #ResponsiveDesign #HealthcareTechnology

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2023-12-11T20:57:44-05:00December 11, 2023|

Meet the Team! – Sean Grimes

Sean Grimes: Professional Growth in a Supportive Culture

At ClaimsBridge, we pride ourselves on our close-knit community and the dedication of our team members. Today, we’re shining a spotlight on one of our long-standing employees, Sean Grimes, who has been instrumental in our growth and success. Sean is a Senior Technical Analyst who creates and maintains our reporting database and user interfaces for ClaimsBridge software solutions. Sean has been with ClaimsBridge for over 9 years.

Why ClaimsBridge?

When asked about how he came to ClaimsBridge, Sean shared a story of small company charm and the allure of a family-like atmosphere. Initially introduced to the company by a former colleague, he was drawn to the relaxed environment and the comfortable atmosphere. “It’s always wonderful to have a casual and relaxed environment. For example, our team can wear casual clothes to the office. I feel I can be more productive and focused when I am working in a comfortable environment,” he shared.

One of his first impressions of the company was shaped by a candid conversation with Bob, the former CEO. His genuine interest in his aspirations and the company’s close-knit nature made him feel right at home. The opportunity to juggle multiple roles and delve into different areas of the company was a significant pull, ensuring no day was monotonous.

“Everybody helps to make the company profitable and move forward. It’s great that we have a common understanding of our goals.”

Work-Life Balance at ClaimsBridge

Sean describes the work-life balance as a blend of challenges and rewards. While there are times when the workload demands extra hours, the company’s understanding nature ensures employees can take breaks when needed. “Everybody helps to make the company profitable and move forward. It’s great that we have a common understanding of our goals,” he noted.

The company’s culture promotes mutual support. Whether it’s covering for a colleague or stepping in to assist with a project, the team always has each other’s backs. This collaborative spirit, combined with management’s genuine care for employees’ well-being, fosters a balanced work environment.

Achievements and Growth

One of Sean’s most significant achievements was revamping the scanning software used for converting paper claims to electronic format. This initiative streamlined the process, enhancing efficiency and reducing manual intervention. “It enabled the mailroom department to significantly reduce the amount of time it took for them to handle the claims,” he stated. “It was an interesting project where I knew I could address the growing need with automating technology and optimized processes. It was really satisfying to know I was helping my colleagues with a very manual, slow, and tedious process.”

Over the years, Sean’s role has evolved, taking on more responsibilities, from training junior programmers to overseeing client implementations. The company’s rapid growth has presented challenges, but with a supportive team and a passion for learning, he has adeptly navigated these changes.

Company Culture and Values

ClaimsBridge’s culture is rooted in camaraderie and mutual respect. The open-door policy ensures everyone’s voice is heard and decisions are made with the company’s and employees’ best interests in mind. “You just get the feeling that nobody’s uptight; everybody’s approachable,” he emphasized.

The company’s growth, from processing 400,000 claims when he started to recently hitting the 100 million mark, is a testament to the team’s dedication and hard work.

Sean’s journey with ClaimsBridge is a testament to the company’s commitment to its values and its people. As we continue to grow and evolve, we remain grounded in our mission to provide a supportive environment where every team member can thrive.

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2023-11-06T16:31:24-05:00December 4, 2023|

Beyond Compliance: How ClaimsBridge is Setting a New Standard in Out-of-Network Cost Containment

In today’s healthcare landscape, one of the most pressing challenges faced by patients and providers alike is the escalating cost of out-of-network (OON) care. As healthcare becomes more complex, the need for solutions that can simplify the process and contain these costs becomes paramount.

Understanding Out-of-Network Costs and the Impact of the No Surprises Act

When patients receive care from providers that are not part of their insurance network, they often encounter higher fees. These OON providers have not negotiated rates with the patient’s insurance company, leading to increased costs that are often passed on to the patient. This can result in unexpected and burdensome medical bills, causing financial strain for many individuals and families, as well as their employers.

The No Surprises Act (NSA), which came into effect in the United States on January 1, 2022, is designed to protect consumers from unexpected and exorbitant medical bills for OON services. The NSA provides for balance billing protection, transparent pricing, an independent dispute resolution (IDR)process, qualifying payment amount (QPA), the advance explanation of benefits, patient-provider dispute resolution options, and requires machine-readable files from HCPs and insurers regarding service costs.

The burden of compliance falls on health plan providers and TPAs to foster a more transparent, fair, and consumer-friendly healthcare environment. As TPAs and health plan providers seek innovative solutions, many forward-thinking companies are turning to ClaimsBridge.

The ClaimsBridge Solution

ClaimsBridge recognizes the challenges posed by high out-of-network costs and is dedicated to transforming the healthcare claims lifecycle with technology-enabled services. With an end-to-end claims ecosystem, ClaimsBridge delivers high-performance solutions that aim to reduce costs, increase accuracy, and set a new standard for the entire healthcare claims process.

Our OON solutions facilitate NSA compliance. ClaimsBridge has teamed up with a leader in healthcare data analytics to automatically update any OON claim with a QPA value. We are prepared to provide health plans with comprehensive services to comply with every aspect of the IDR Process from the commencement of the Open Negotiation Period to the final resolution. The ClaimsBridge Celerity Engine also delivers machine-readable files, and the NSA-required “allowed amount” file.

Beyond compliance, we like to show quick results that directly address cost containment and efficiency – for clients and prospective clients. We often engage health plans and TPAs in a brief yet incredibly valuable claims file analysis activity that quickly illustrates potential cost savings and ROI. Since we are already integrated with over two dozen claims adjudication platforms, we can usually implement 2-way connectivity within weeks. We then establish pricing parameters, adjust OON products to include options such as full legal support, configure the features of the programs at an employer group level, and adjust pricing based on employer, geography, and provider type. The flexibility and custom nature of the solution extend to pricing models as well. Our pricing structure can be based on a percentage of savings or flat PEPM and can be adjusted by employer group.

ClaimsBridge already integrates with custom provider networks, offers clearinghouse capabilities, and routes to national networks, so we can add OON services with efficiencies of scale. While our competition may execute similar programs, they can’t offer similar results because most are larger organizations saddled with large overhead expenses, manual processes, and legacy technologies. By combining advanced technology and industry expertise within an intentionally lean organization, ClaimsBridge can deliver custom cost-containment services that meet the challenge of out-of-network costs. Our out-of-network services provide a comprehensive approach to managing these claims, ensuring cost containment across the ecosystem.

Conclusion

As the healthcare industry continues to evolve, the problem of high out-of-network costs remains a significant concern. However, with innovative solutions like those offered by ClaimsBridge, there is hope for a more streamlined and cost-effective future for healthcare claims. By prioritizing accuracy, efficiency, and patient well-being, ClaimsBridge is leading the way in containing healthcare costs and simplifying the claims process for all involved.

We believe you are paying too much for out of network claims. At ClaimsBridge, we are committed to delivering real and measurable value to our clients. We stand behind our promise with both fee and savings guarantees:

Beyond compliance, we like to show quick results that directly address cost containment and efficiency – for clients and prospective clients. We often engage health plans and TPAs in a brief yet incredibly valuable claims file analysis activity that quickly illustrates potential cost savings and ROI. Since we are already integrated with over two dozen claims adjudication platforms, we can usually implement 2-way connectivity within weeks. We then establish pricing parameters, adjust OON products to include options such as full legal support, configure the features of the programs at an employer group level, and adjust pricing based on employer, geography, and provider type. The flexibility and custom nature of the solution extend to pricing models as well. Our pricing structure can be based on a percentage of savings or flat PEPM and can be adjusted by employer group.

ClaimsBridge already integrates with custom provider networks, offers clearinghouse capabilities, and routes to national networks, so we can add OON services with efficiencies of scale. While our competition may execute similar programs, they can’t offer similar results because most are larger organizations saddled with large overhead expenses, manual processes, and legacy technologies. By combining advanced technology and industry expertise within an intentionally lean organization, ClaimsBridge can deliver custom cost-containment services that meet the challenge of out-of-network costs. Our out-of-network services provide a comprehensive approach to managing these claims, ensuring cost containment across the ecosystem.

Fee Guarantee:

No Surprises

Fee Guarantee:

We offer transparent pricing, with no hidden fees or surprises. You’ll know exactly what you’re paying for, allowing you to budget with confidence.

Savings Guarantee:

Significant Impact

Savings Guarantee:

When you choose ClaimsBridge, you’re choosing savings. We guarantee that you’ll see a significant reduction in out-of-network costs when you partner with us.

2023-11-21T11:33:58-05:00November 21, 2023|
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