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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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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, 2024 – Inc. 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
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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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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The Link: Inaugural Issue
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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.
