Many self-insured organizations facing increasing healthcare costs consider reference-based pricing (RBP) models as a viable cost-containment strategy. RBP offers increased flexibility and transparency at reduced costs for employers while reducing out-of-pocket spend for employees.

ClaimsBridge Navigator Pricing Solutions simplify the implementation of referenced-based pricing and enable employers to choose the level of support they need to maintain an RBP model successfully.

Essential – The Essential offering includes comprehensive claims capture and pricing using the ClaimsBridge Celerity pre-adjudication engine.

  • Application of Medicare pricing rules and establishment of MAC
  • NCCI/MUE edits, gap filling
  • Coordination of medical bill review
  • Routing to network vendor(s)
  • Web Portal and Landing Page creation
  • Optional ClaimsBridge Navigator Network Access

Premier – The Premier offering includes all the great component services of Essential and adds advocacy and support:

  • Collaboration with Administrator Service Team
  • Customer Support tools
    • ClaimsBridge Dedicated Support Line & Personnel to manage pre-certification, provider appeals, balance billing triage, and single case agreements, with Service Level guarantees
  • ClaimsBridge Approved Legal Defense Partner
  • Patient Advocacy
  • Administrator selects stop-loss insurance
  • Optional ClaimsBridge Navigator Network Access

Premier Select – The Premier Select offering includes all the component services of Premier with the addition of:

  • ClaimsBridge approved stop loss partner
  • Optional ClaimsBridge Navigator Network Access

ClaimsBridge Navigator Pricing Solutions are customizable and provide a single-source solution for a full RBP experience. Flexible add-ons and optional support services enable organizations of any size to implement a successful RBP model.

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