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.

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.

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.

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.