ClaimsBridge Sponsors HPI’s 2025 Innovations in Self-Funding Conference
ClaimsBridge Sponsors HPI’s 2025 Innovations in Self-Funding Conference
We’re thrilled to announce that ClaimsBridge is a proud sponsor of HPI’s 2025 Innovations in Self-Funding Conference in Boston from April 28–30! This premier event brings together top industry professionals to discuss the future of self-funded healthcare, innovative cost-saving strategies, and cutting-edge technology solutions.
At ClaimsBridge, we are committed to streamlining claims processing and optimizing healthcare payment solutions. Sponsoring this event aligns with our mission to drive efficiency and transparency in self-funded healthcare.
📅 Join us in Boston! If you’ll be attending, we’d love to connect and discuss how ClaimsBridge can help simplify your claims processing needs.
Stay tuned for more updates as we get closer to the event!
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Meet the Team! – Lauren Larsen
Employee Spotlight: Lauren Larsen: A Career of Growth and Impact at ClaimsBridge
At ClaimsBridge, we believe that our greatest strength lies in our people—their passion, dedication, and commitment to making a difference in healthcare. In this interview, we spoke with a long-time team member who has been with ClaimsBridge since 2012. She shares her journey from first discovering our company to playing a pivotal role in expanding our provider network. Her story highlights not only professional growth but also the culture of support, innovation, and teamwork that defines ClaimsBridge.
” The work-life balance at ClaimsBridge is unmatched. Leadership genuinely cares about the well-being of employees and their families, making it a place where you can grow your career without sacrificing what matters most.”
What initially attracted you to join our company, and what has made you stay?
I started with the company in 2012. ClaimsBridge was a vendor with my previous employer, and I met Bob and Jessica through the implementation process. I thoroughly enjoyed working with them and recognized that their products and services were crucial to the healthcare industry. A few months later, ClaimsBridge was in the process of acquiring part of my previous employer’s business, and as a result, I was offered a job. I knew Bob led a wonderful team of employees and created and utilized cutting-edge technology, so it was a natural transition for me to work for ClaimsBridge and continue to grow in my role and responsibilities.
How would you describe the work-life balance at our company? What support or resources have you received to help maintain that balance?
The work-life balance at ClaimsBridge is unmatched. My family grew after I started with the company, and I was fortunate to experience our “family first” culture. The leadership team genuinely cares about the well-being of all employees and their families. I appreciate that ClaimsBridge operates under an “open-door policy”. It’s comforting to know that employees can always talk to someone if needed, whether it’s work-related or personal.
Can you describe your most significant achievement or project during your time at the company and how it impacted the organization?
When I first started at ClaimsBridge, I was responsible for building a large provider network in Delaware and Maryland, which involved contracting with over 5,000 providers for more than 30 employer groups. It was a huge undertaking! I had numerous meetings with our I.T team, who did an outstanding job of enhancing our system to accommodate the provider contracts. This included automating complex rate structures and adding a provider directory website for each employer, amongst other enhancements. Once the network was in production, I not only managed the entire network, but I also helped answer member questions and provided customer service to clients as well.
Since then, we have been able to leverage the same platform to expand our business into other areas, such as pricing claims for other networks, and RBP pricing.
How has your role evolved since you joined the company, and what steps have you taken to adapt to those changes?
Great question! My initial role was a provider network contractor/claims analyst, and now I am in a broader role of network account management, while still entering complicated provider contracts and reviewing high-dollar claims. I am also involved in the implementation of new clients, which includes entering provider contracts and rates, as well as testing the claims to confirm they are pricing correctly before going into production. Post-implementation, I ensure all claims continue to price accurately, as well as update provider contracts with annual rate increases, and handle any issues/questions that arise in the meantime.
I have been pulled into numerous projects over the years and participate wherever they need me. I’ve attended open enrollment/benefit fairs for multiple clients to help explain our products and provider network to their employees; I have also attended industry conferences to represent ClaimsBridge and tell others about who we are and what we do.
How do you think our company’s culture and values impact the way we work and make decisions?
Leadership consistently demonstrates respect for everyone, and that is truly felt throughout the company as a whole. Employees often step in to provide extra help when needed, and we all support one another by covering for colleagues when someone is out of the office.
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Building Smarter Healthcare Networks: How Quality Care Partners & ClaimsBridge Drive Efficiency
Cindy Baker, CEO of Quality Care Partners, shares how their partnership with ClaimsBridge improves claims pricing, streamlines payments, and drives cost-effective healthcare solutions.
Read time: @ 6 minutes
Can you give us a brief overview of Quality Care Partners and your role within the organization?
Cindy Baker, BSN, MSA
Quality Care Partners was founded in 1995 as an organization to bring physicians and hospitals together to create infrastructure to manage care, as well as an entity to focus on third party opportunities for risk and managing risk. I’m the CEO.
What are the primary services that Quality Care Partners provides and what distinguishes your approach in the healthcare industry?
Cindy Baker, BSN, MSA
We’ve created a network of select providers across Ohio to partner directly with employers. We have been doing direct provider contracts with employers since 1996. Most of our audience are self-funded employers. We help employers, physicians and hospitals understand each other’s challenges, what drives health care spend and how to best control it.
We believe this sets us apart; helping employers understand what goes into the cost of health care and understanding how they can contribute to driving down spending by aligning benefit design to incentivize members to utilize the lower net cost sites of service or service types.
We have built medical management services around cost containment strategies so that we would not just be creating a network to provide great contracts and discounts but also be able to combine the strength of clinical expertise and advocacy for patients. This enabled patients to go through the system in an efficient way and get to the care that they need in the most cost-effective way.
How did the partnership between Quality Care Partners and ClaimsBridge begin, and what were the initial goals?
Cindy Baker, BSN, MSA
We were given an opportunity to work with ClaimsBridge because we are part of a statewide
initiative which aligns three provider sponsored networks to create a statewide Ohio preferred provider network. Our organization was one of the founding Members and remains one of three partners with Ohio State Health Plan and Ohio Health Choice. ClaimsBridge was contracted as our traffic cop, or the data integrator and aggregator. They provided us with a third-party infrastructure to manage all of the claims and point all of those claims in the right direction.
Quality Care Partners separately contracted with ClaimsBridge to manage all the repricing for the contracts we hold with our providers. Since 2012, ClaimsBridge has efficiently applied multiple methodologies for pricing provider claims. Their technology has allowed us to apply Medicare pricing methodology to the specificity of the then current actual provider CMS tables assigned to that provider rather than a blended aggregate rate. QCP is enabled to be creative with contracting and be the liaison between the provider and Third-Party Administrator to create a seamless, efficient, accurate price. Providers have the assurance that they are getting paid the contracted rates.
What key benefits has Quality Care Partners experienced through their collaboration with ClaimsBridge?
Cindy Baker, BSN, MSA
I think primarily for us; it’s being able to manage the entire claims pricing process and have a backroom partner that has truly all of the tools and resources to give us the ability to be competitive in the market.
We’ve been able to design multiple product network configurations and they’ve been able to manage the sourcing of those claims to all the average turnaround time from receipt from clearinghouse to electronic submission to TPA is less than one day. It allows for an integrated, one-stop shop, where claims go through one portal, and never has to leave that portal. Whether it’s in-network, out-of-network or is eligible for a Qualified Payment Amount, it can be priced before returning to TPA ready to adjudication.
If there are alternate networks, such as our statewide Ohio network, Ohio PPO Connect, those claims are forwarded electronically to those alternate entities without it having to pass through multiple vendors’ hands. It creates a vertically integrated solution for our clients. This works extremely well and allows QCP to keep costs lower for employers/plans.
Turnaround times are remarkable. We’re less than a day on an electronic clean claim coming into the system, is repriced and goes back to the third-party administrator. The paper conversion has also been under four days on average year over year.
Can you share an example, or can you bring to mind a specific challenge that ClaimsBridge helped you overcome?
Cindy Baker, BSN, MSA
First is ClaimsBridge’s ability to address compliance issues with the Consolidated Appropriations Act with the MRF file requirements. They have been our solution for all things related to that, as well as out of network pricing solutions for our clients.
Second is their ability to do true Medicare based methodology. There are many tables involved when contracts are written to price to Medicare. For a hospital, there might be 13 different tables that have to be downloaded. It’s not as easy as saying, there’s a rate for this hospital in Kansas City, and that’s the rate that you would pay everyone in Kansas. Specific rates and methodology are applied and current.
ClaimsBridge pricing infrastructure allows applications which are true to today’s Medicare rate. Providers state that competitors’ contracts may state they are pricing Medicare, but it’s the day you signed the contract, and they don’t want to update the tables ever.
How has the integration of ClaimsBridge’s solutions impacted your operations and the services you provide for your clients?
Cindy Baker, BSN, MSA
ClaimsBridge has enabled us to have a one-stop vertically integrated solution and provide industry expertise behind us, so we didn’t have to build it.
We rely on their technology and expertise very heavily to keep us in front of the market and keep us moving forward in meeting market demands. They additionally have relationships with multiple health systems around the country to allow QCP to meet the needs of employers out of state members at market favorable rates.
What improvements in efficiency, or cost management have you observed because of this partnership?
Cindy Baker, BSN, MSA
I think it’s the ease of the contract administration and implementation. Efficiency is obviously the flow of the claim and the turnaround time to ensure TPA’s have the correct information they need to adjudicate the claim timely, and providers’ payments are not delayed. Providers that can reduce administrative time in revenue management are more likely to partner with employers for more favorable pricing.
QCP has used our ability to get access to Medicare pricing to get better results for our employer clients. We can leverage the information that we have to be able to steer patients into the lower cost alternatives.
In what ways has ClaimsBridge’s technology enhanced your ability to meet your clients’ needs or achieve your strategic objectives?
Cindy Baker, BSN, MSA
The challenges that we were having prior to our engagement with ClaimsBridge were related to the multiple methodologies that can occur when we contract with providers. When you have multiple methodologies within one provider contract it is very difficult to build all of that technology, keep current and manage it correctly. Additionally, providers want to know what payment they can expect and trust.
Providers need to trust that claims will be administered in accordance with their contract terms. That’s one of the primary reasons we wanted to bring this in-house and be able to manage it ourselves. ClaimsBridge technology gives QCP the confidence we need to work with providers and employers on benefit and contract applications.
As you look ahead what are you excited about regarding the continued collaboration between Quality Care partners and ClaimsBridge?
Cindy Baker, BSN, MSA
I think what we find most beneficial with ClaimsBridge is they are very like-minded to Quality Care Partners. They’re looking to build business strategies with us that will help us stay relevant and to be market competitive as we move forward. QCP aligns with partners that have vested interest in our growth and want to be part of mutual success. Kevin Gibson and his team are open to ideas and they’re eager to look at ways to continue to build not only for QCP but for all of their clients.
Is there anything else you’d like our audience to know about Quality Care Partners in closing?
Cindy Baker, BSN, MSA
IQCP has developed over the last 15 years to greatly expand our footprint in Ohio and services. Established and founded in southeast Ohio, we have an extremely strong network and are proud of the employers and plan administrators that have entrusted us with their plan partnerships. We’ve been able to maintain and grow relationships because we are provider-centric, we’re managed and governed by physicians and employers, and that gives us a different view on patient care and contracting.
We understand the payment methodologies. We understand challenges from both sides of the table when it comes to healthplan compliance and spend. We understand we’re spending the money of an employer every time a decision is made, and we like to partner with providers and vendors that understand that as well. Our whole goal is to provide low net cost to employers and find business partners that are also interested in keeping costs low for employers. Clean and efficient administration of customizable solutions brings higher value to our clients.
We understand the payment methodologies. We understand challenges from both sides of the table when it comes to healthplan compliance and spend. We understand we’re spending the money of an employer every time a decision is made, and we like to partner with providers and vendors that understand that as well. Our whole goal is to provide low net cost to employers and find business partners that are also interested in keeping costs low for employers. Clean and efficient administration of customizable solutions brings higher value to our clients.
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Meet the Team! – Jason Werner
Employee Spotlight: Jason Werner, CIO: Building a Legacy: Growth, Stability, and Innovation at ClaimsBridge
We recently had the opportunity to chat with Jason Werner, CIO and a key member of the leadership team at ClaimsBridge to uncover their unique journey with the company and explore what makes ClaimsBridge an exceptional place to work. Their story is one of dedication and growth, supported by a company culture that values stability, family, and personal development, all within the framework of a thriving and dynamic work environment.
You’ve been with the company for a long time. Tell us a little bit about what it was like in the early days and how the company has evolved since then.
In the early days, we operated paycheck to paycheck like many young companies. Jak, Bob, Melissa, and Jessica were here before me. We scrutinized every expense, ensuring each project or client relationship was worth it. Bob often shared stories of driving to collect checks to make payroll.
For years, our main challenge was managing limited cash flow without incurring debt. Despite this, we grew organically and steadily, never retreating. I occasionally read that once a company hits a certain financial threshold, such as $200,000 in the bank, growth accelerates. Initially, our 10-30% growth was consumed by expenses. It took time before our growth translated into significant profits.
The first decade was tougher because every penny earned was reinvested. Today we have grown to the point where this is still in the back of our mind, but we have more flexibility overall. This financial stability is the biggest change.
What hasn’t changed is our family-oriented culture. We’re supportive of employees with new children and prioritize their needs without pressuring productivity. This support, initiated by Bob, remains a core value at ClaimsBridge, even as we grow.
What has made you stay with ClaimsBridge?
Before joining ClaimsBridge, I worked for a consulting company where I traveled extensively. I spent a year in Oklahoma City, three years in California and Chicago, and was slated to go to Albany. My wife and I were starting a family and moving to Annapolis, so I needed to find something different.
Coming here I found a local job that offered growth opportunities. It allowed me to do things I only got to do briefly in consulting, where you come in, do a job, and then leave. This job gave me long-term experience in IT and the chance to be involved in different aspects of the business.
When I joined the company, I started as a programmer. Although I had extensive programming experience, it wasn’t in the language we used here. I had worked a lot with MUMPS in VA hospitals, where most programmers were much older. I wanted to learn a more marketable language, and Jak Eskinazi hired me, saying he could teach me what I needed to know.
I started by learning the new programming language and evolved from there. As we grew, I took on more supervisory and managerial roles, though managing isn’t my strongest skill. My style is more consultative—I expect people to do their jobs and move on. Now, I run the IT department and am involved in business decisions. I try to stay away from some decisions to avoid conflicts, but my job is to keep everything running smoothly and advance our capabilities.
I don’t program as much as I used to and am more specialized in what I do, but I still code daily. One thing that hasn’t changed, which I’d like to change, is my involvement in customer support. Many customers reach out to me directly for issues, and I spend a lot of time troubleshooting and fixing problems. Being a hands-on company is important to us, and maintaining that during growth is one of our biggest challenges.
Can you describe your most significant achievement or project during your time at the company and how it impacted the organization?
About five or six years ago, before our new leadership team came onboard, and the new team joined us, Bob and I received a call from a long-term client, the Loomis Company, a TPA subcontracted through Bright Health Group for their commercial operations. They needed help with pricing claims, and we told them, “That’s what we do.”
This project was a significant revenue boost for us. I handled all the coding, logic, and pricing, integrating our system with their complex, hospital-based pricing rules. These were challenging tasks, representing the difficult 10% of the work that takes most of the time.
Over that year, we successfully implemented the system and supported them for three years until Bright Health moved on from that business. Despite this, the project was a major success for us, both personally and as a company.
The revenue from this project allowed us to hire Kevin Gibson – CEO, Mike Tosti – EVP Sales, and our current sales team, which has driven our growth. This project was our “hockey stick” moment, accelerating our success significantly.
“From an employee perspective, we’ve consistently taken care of everyone, prioritizing their well-being over the company’s bottom line. This approach hasn’t changed.”
Where do you see ClaimsBridge heading in the future?
Looking ahead, from a business and investor perspective, we’re focusing on substantial growth. We plan to continue expanding, potentially by acquiring or partnering with like-minded or complementary businesses. There’s also the possibility that someone might see value in us and want to invest further.
Overall, the company is on solid footing for long-term growth and continued industry support.
How do you think ClaimsBridge’s culture and values impact the way you work as a team and how you make decisions with a company?
That’s a great question. From an employee perspective, we’ve consistently taken care of everyone, prioritizing their well-being over the company’s bottom line. This approach hasn’t changed.
From a management perspective, growth has made things more challenging. With more employees, there’s a greater responsibility to ensure everyone gets paid. When the company was smaller, decisions were easier and risks were manageable. Now, with around 25 employees, there’s more at stake, which affects our decision-making structure.
Despite the growth and changes we remain heavily client focused. Keeping our clients happy is key to enabling us to continue to grow. This is something I take great personal pride in.
Anything Else you’d like to add?
This is a great place to grow, especially in the tech sector. We’re an IT company providing valuable services to our clients, but without our IT backbone, we wouldn’t have much to offer. The company’s growth potential is enormous in terms of client product offerings, and both business and personal development.
You often hear we’re a 20-year-old startup because, for the first 16-17 years, we operated with minimal resources. Now, we’re fixing things we should have done from the beginning. We’ve achieved SOC 2 compliance, moved our hosting to an Azure cloud environment, and added new tools to stay current with the evolving tech landscape.
Our modernization efforts mean new employees can find their niche and grow. I’m happy to delegate tasks because I can’t manage everything like I did a decade ago. When new hires express interest in areas like cybersecurity, we can support them in those roles.
From a growth standpoint, it’s like my adult soccer team where everyone wants to play offense. We need balance, hiring people for specific positions we need, even though we have many roles to fill.
There are many opportunities and a lot of fun in the process. It’s a great place for hiring and future growth.
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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.
