The healthcare industry has looked to Medicare as a national benchmark for what is considered to be an acceptable payment for covered medical services.


ClearHealth’s technology and Medicare RBP methodology support your cost management objectives with transparent, industry-accepted reimbursement.

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While we aim to help address your out-of-network challenges with our unparalleled Medicare RBP methodology, we also provide supplemental services to round out your entire Network strategy.

 

Utilize any one or a combination of the ClearHealth solutions to build an end-to-end reimbursement strategy that seamlessly integrates with your claim adjudication system.

  • Out-of-Network claim valuation
    Achieve the highest net retained savings and the least noise with this transparent offering
  • Identify problem billers
    Identify and shut down egregious billing practices
  • Target pricing
    Appropriately price claims based on a chosen level of Medicare
  • Network configuration
    Integrate your various network relationships with Medicare RBP to build a robust cost management solution
  • Partial- to full-network replacement
    Customize payer-specific objectives while enhancing the patient experience
  • Provider service valuation for non-traditional entities
    Create a pricing index and benchmark for nontraditional entities, such as health care cost sharing communities

WHO WE SERVE

Insurance carriers

Third party administrators (TPAs)

Stop-loss carriers

Workers’ compensation and auto medical bill review organizations

Health care cost sharing communities

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Talk to us about how we can best fit your plan’s needs.


  • All claims outside of a primary PPO network.

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  • Fully replace the PPO network.

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  • Replace facility or professional providers.

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  • Reliable pricing for your provider agreements.

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