Reference Based Pricing Services
6 Degrees Health SIIA Member
Heath Potter, Senior Vice President
5800 North East Pinefarm Court, Suite 200
Hillsboro, OR 97124
Phone: (503) 640-9933
Email: Heathpotter@6degreeshealth.com
Website: www.6degreeshealth.com
6 Degrees Health is built to bring equity and fairness back into the healthcare reimbursement equation. Our cost containment efforts utilize MediVI technology, which supports our solutions with objective, transparent and defensible data. Solutions include everything from provider market analyses, reasonable value claim reports, claim negotiations, and referenced based repricing.
AccuRisk Solutions, LLC SIIA Member
Dan Boisvert, President & Chief Executive Officer
10 South LaSalle Street, Suite 3450
Chicago, IL 60603
Phone: (312) 857-9100
Email: info@accurisksolutions.com
Website: www.accurisksolutions.com
AccuRisk Solutions, LLC is a Chicago-based Managing General Underwriter focused on providing its producers with innovative insurance products and outstanding customer service. We have partnered with leading insurance carriers and healthcare industry visionaries to provide a comprehensive array of healthcare and employee benefit solutions to meet your employer clients’ needs.
Advanced Benefit Consulting & Insurance Services, Inc. SIIA Member
Dorothy Cociu, RHU, REBC, GBA, RPA, President
5130 E. La Palma Avenue, Suite 211
Anaheim, CA 92807
Phone: (714) 693-9754; Toll Free (866) 658-3835
Email: dmcociu@advancedbenefitconsulting.com
Website: www.advancedbenefitconsulting.com
We are a full-service health insurance agency and consulting firm, specializing in self-funded group health plans, including reference based pricing plans. Our senior management comes from years of experience in the self-insured TPA business. We are benefit as well as compliance consultants, including HIPAA, COBRA, ACA and other compliance issues.
CareValet SIIA Member
Aaron Kessinger, President
4913 West Laurel Street
Tampa, FL 33607
Phone: (866) 549-9533
Email: aaron@carevalet.com
Website: www.carevalet.com
CareValet is a technology platform designed for TPAs to customize a guided consumer experience including provider locators, telehealth and online appointment setting. Our solution is ideal for reference based pricing, direct provider contracting and network structure defined at the employer level. CareValet can be your member web and app service.
Claim Watcher/Homestead Smart Health Plans SIIA Member
William Green, Chief Executive Officer
50 South 16th Street
Philadelphia, PA 19102
Phone: (844) 307-3788
Email: bill.green@homesteadplans.com
Website: www.homesteadplans.com
Homestead offers an innovative RBP model creating a healthier bottom line for employers. We enable employers and employees to save up to 30% through Claim Watcher, our proprietary auditing and repricing solution, while improving quality for employees. Learn more about our win-win full BUCA replacement, slice offering, or out-of-network solutions.
ClaimDOC SIIA Member
Timothy Hyde, President
506 3rd Street, Suite 200
Des Moines, IA 50309
Phone: (501) 779-6708
Email: Ben@Claim-DOC.com
Website: www.Claim-DOC.com
Your third party claim auditing and member advocacy firm. We offer our services as co-fiduciary to plan sponsors. Appeal and balance bill handling as well as litigation defense and support.
ClearHealth Strategies SIIA Member
Brian Wroblewski, Executive Vice President - Sales & Marketing
27299 Riverview Boulevard, Suite 100
Bonita Springs, FL 34134
Phone: (414) 899-4100
Email: bwroblewski@clearhealthstrategies.com
Website: www.clearhealthstrategies.com
ClearHealth Strategies is a leading turnkey reference-based pricing organization offering out-of-network (behind PPO), partial or full PPO replacement, or contract-management capabilities using Medicare as the pricing source. ClearHealth offers the most comprehensive claim pricing and program configuration available, and is trusted by health plans and third party administrators across the country.
ELAP Services SIIA Member
Steve Kelly, Co-Founder & Chief Executive Officer
1550 Liberty Ridge Drive, Suite 330
Wayne, PA 19087
Phone: (610) 321-1030 Ext. 108
Email: mmcdonald@elapservices.com
Website: www.elapservices.com
ELAP Services is a leading reference-based pricing solution for self-funded employers, offering unparalleled cost savings and advocacy services. Since 2007, ELAP has helped organizations in the US reduce their healthcare spend by as much as 30%. ELAP collaborates with health systems across the nation to build bridges with employers in the communities they serve. Through direct contracts, these partnerships offer new, cost-efficient healthcare solutions to local companies and a strong alternative to traditional PPO plans.
Fairos SIIA Member
John Fabrizio, Senior Vice President, Business Development
1800 South Washington, Suite 300
Amarillo, TX 79102
Phone: (410) 382-0408
Email: john.fabrizio@fairos.com
Website: www.fairos.com
Fairos specializes in successfully executing reference-based pricing strategies. Employing the expertise that has made us the industry’s leading medical contracting firm, we have developed the next generation of RBP intellectual capital which dramatically improves member experience while delivering industry-leading cost savings.
Gilsbar SIIA Member
Doug Layman, President of Health & Life
2100 Covington Centre
Covington, LA 70433
Phone: (800) 445-7227
Email: gilsbarmarketing@gilsbar.com
Website: www.Gilsbar.com
For more than half a century, Gilsbar has offered services and solutions for businesses looking for happier constituents and healthier bottom lines. As one of the nation’s largest privately held health and benefits management organizations, Gilsbar delivers an unwavering commitment to partnerships guided by a corporate vision focused on the clients we serve—employers, brokers, consultants, affinity groups, insurance carriers and more. These professionals choose Gilsbar for our innovation, ingenuity, knowledge and world-class service. Our expertise makes Gilsbar the trusted choice for clients across the nation.
Golden Triangle Specialty Network SIIA Member
Hy Byrd, Chief Operating Officer
2195 Osburn Road
Arrington, TN 37214
Phone: (615) 712-6289
Email: byrdh@gtspecnet.com
Website: www.gtspecnet.com
Golden Triangle Specialty Network is a medical cost containment company with a proven track record in delivering secure savings for both dialysis and medical spend specialty pharmacy. Contact GTSN to learn more about GTRx and how our holistic approach can deliver significant savings for self-insured clients.
Health Cost Control SIIA Member
Scott Swarts, Vice President Client Services
922 14th Street North #101
Texas City, TX 77590
Phone: (866) 751-1599
Email: sswarts@healthcostcontrol.com
Website: www.healthcostcontrol.com
Health Cost Control is a leading national provider of cost containment solutions. Drawing from a range of services, we’ll create a customized program to deliver outstanding results. HCC provides specialized services including Medical Bill Review, Reference-Based Pricing, Dialysis Claim Review, Air Ambulance Review, Behavioral Health Review and Patient Advocacy.
HealthSmart SIIA Member
Ron Wozny, Vice President of Marketing
222 West Las Colinas Boulevard, Suite 500N
Irving, TX 75039
Phone: (214) 574-2362
Email: ron.wozny@healthsmart.com
Website: www.healthsmart.com
HealthSmart is one of the largest third party administrators of self-funded health plans and the premier provider of innovative, customizable healthcare and claims solutions for employers, brokers and payers. We offer benefit administration, pharmacy solutions, provider networks, care management and wellness programs, as well as claims and administration services for property, casualty and workers’ compensation.
Hi-Tech Health, Inc. SIIA Member
Michael Carrara, President
1500 Route 517
Hackettstown, NJ 07840
Phone: (908) 813-3440
Email: mcarrara@hi-techhealth.com
Website: www.hi-techhealth.com
If you’re a “startup” Third Party Administrator, just entering the self-insurance industry, an insurance company, union, large corporation, or small brokerage firm wanting control of your client’s health care claims through a turnkey, customized Claim Administration System, then your organization needs Hi-Tech Health, Inc. Please visit our website for more information regarding Custom Software Solutions that will allow you to run your business YOUR way.
Hopewell Risk Strategies, LLC SIIA Member
Leo Oliver, Director
18090 Kings Row
Houston, TX 77058
Phone: (800) 293-1397
Email: leo.oliver@hopewellgrp.com
Website: www.hopewellrsk.com
Hopewell's bill review product is designed to provide significant reductions in medical claim costs in concurrence with timely and accurate payment recommendations. Hopewell Risk Strategy provides industry leading medical claim review services. We provide state-of-the -art bill review and repricing solutions for group health medical claims.
HST SIIA Member
Ryan Day, President
23382 Mill Creek Drive, Suite 200
Laguna Hills, CA 92653
Phone: (949) 682-7692
Email: rday@hstechnology.com
Website: www.hstechnology.com
Since 2009, HST’s alternative health plan has delivered Value-Based Payments (VBP) to over 700,000 members. HST’s pricing technology provides cost benchmarks which help objectively determine the value of medical services and introduce pricing accountability. We have successfully established a sustainable benefit plan that represents quality and transparency and has helped cut our groups healthcare cost by an average of 22%.
IHS - ClaimsBridge Direct SIIA Member
Robert Schmidt, President
1511 Ritchie Highway, Suite 205
Arnold, MD 21012
Phone: (410) 349-3222
Email: rschmidt@claimsbridge.com
Website: www.claimsbridge.com
ClaimsBridge Direct provides cost containment for self-funded plans through its custom provider networks using Medicare based direct contracts customized to the self-funded plan’s medical services need. ClaimsBridge Direct reduces the self-funded employer’s medical spend and growth trend, without the financial risk of large network or reference based (“no network”) solutions.
Maestro Health SIIA Member
Jillian Best
500 West Madison Street
Chicago, IL 60661
Phone: (312) 517-3500
Email: jbest@maestrohealth.com
Website: www.maestrohealth.com
Maestro Health is on a mission to make employee health & benefits people-friendly again. Our innovative health plan management approach to self-funding, known as (me)SELF-FUNDED BENEFITS‚Ñ¢, integrates the best technology, high-quality care and personalized service to improve the health of employees and lower costs for employers.
MultiPlan SIIA Member
Kurt Fullmer, Vice President, Sales and Account Management
222 West Las Colinas Boulevard
Irving, TX 75039
Phone: (972) 884-1401
Email: kurt.fullmer@multiplan.com
Website: www.multiplan.com
MultiPlan is committed to helping healthcare payers manage the cost of care, improve their competitiveness and inspire positive change. Leveraging sophisticated technology, data analytics, and a team rich with industry experience, the company interprets clients’ needs and customizes innovative solutions that combine its payment integrity, network-based and analytics-based services.
National Underwriting Services, Inc. SIIA Member
Dana Driscoll, FLMI, Executive Vice President
14893 S.H. 16 North, Suite 1
Helotes, TX 78023
Phone: (210) 695-2381
Email: ddriscoll@nus1.com
Website: www.nus1.com
National Underwriting Services, Inc. has provided turn-key underwriting, administration and management services for innovative and customized stop loss solutions for over 34 years. NUS has become the expert underwriter for reference based pricing, direct contract plans and other specialty programs including captive underwriting and administration.
Nova Healthcare Administrators SIIA Member
Todd Martin, National Sales Director
6400 Main Street, Suite 210
Buffalo, NY 14221
Phone: (716) 932-5105
Email: tmartin@novahealthcare.com
Website: www.novahealthcare.com
Nova offers personalized service with a tailored approach to cost management and customized, actionable strategies to improve health plan performance. Beyond traditional administrative services, Nova supports plans with DPC and RPB leveraging in-house medical management, HSA, FSA and HRA products. Nova also provides a variety of private-labeled solutions.
OptiMed Health Partners SIIA Member
Rusti Greis, Director, Industry Relations & Market Access
6480 Technology Avenue, Suite A
Kalamazoo, MI 49009
Phone: (877) 232-2857
Email: rgreis@optimedhealthpartners.com
Website: www.OptiMedHealthPartners.com
OptiMed Health Partners specializes in ensuring competitive and innovative cost containment strategies focused on specialty pharmacy and clinical programs that not only minimize the price you pay, but maximizes the value you receive.
Payer Compass SIIA Member
Kellie Jackson, Vice President, Sales and Client Engagement
5800 Granite Parkway, Suite 450
Plano, TX 75024
Phone: (833) MY.PAYER
Email: info@payercompass.com
Website: www.payercompass.com
Follow the leader in innovative reimbursement strategy. We provide healthcare cost containment solutions with best-of-breed technology for Medicare, Medicaid, Commercial and RBP plans. We champion the initiatives of Third-Party Administrators, Self-Insured Employers, Benefit Advisors, Health Plans and Stop-Loss Carriers, building trust and credibility with plan savings of 65%+.
PayneWest Insurance SIIA Member
Troy Kane , Managing Director of Benefit Planning
3289 Gabel Road, P.O. Box 30638
Billings , MT 59102
Phone: (406) 238-1990
Email: tkane@paynewest.com
Website: www.paynewest.com
We’ve made a science out of analyzing health plan risks. We dive in to the chronic conditions affecting your employees and we obsess over identifying ways to control claims costs and promote healthy lifestyles that minimize potential future health catastrophes. Then we put ideas to work, that include short and long term goals. We employ a three to five year strategy that demonstrates the difference we’re making – not only for the health of your employees, but also for the health of your bottom line.
RMC Group SIIA Member
Ashley Simpson, Marketing Manager
27200 Riverview Center Boulevard, #311
Bonita Springs, FL 34134
Phone: (239) 298-8210
Email: asimpson@rmcgp.com
Website: www.rmcgp.com
RMC Group is an international provider of insurance, risk management, retirement and actuarial consulting services. From around the globe, our professionals help advisors, employers, and individuals anticipate, quantify, and understand the risks they face. We work with clients of all sizes to define, design, and deliver solutions to better manage risk.
Specialty Care Management, LLC SIIA Member
Robert Clemente, FACHE, President & Chief Executive Officer
39 Iron Hill Road, Suite 18-20
Doylestown, PA 18901
Phone: (908) 229-1876
Email: bclemente@specialtycm.com
Website: www.specialtycm.com
Taking a new approach to managing dialysis claims, SCM provides a complete risk solution that normalizes costs and reclaims your renal spend. With exclusive dialysis programs featuring flat case rates, no set-up fees, and a full administrative carve-out, SCM doubles your savings compared to typical network discounts, delivering maximized savings.
The Health Plan SIIA Member
Richard Legg, Vice President
1110 Main Street
Wheeling, WV 26003
Phone: (740) 699-6260
Email: rlegg@healthplan.org
Website: www.healthplan.org
We are a fast growing TPA as well as an insurance carrier, offering fully insured plans, doing government programs administration. Our clinical services are best class in the industry, along with our claims processing, customer service. We have our own Behavioral Health Unit, our own Prescription Benefit Manager.
The Phia Group, LLC SIIA Member
Adam Russo, Esq., Chief Executive Officer
163 Bay State Drive
Braintree, MA 02184
Phone: (781) 535-5622
Email: arusso@phiagroup.com
Website: www.phiagroup.com
The Phia Group’s mission is to reduce the cost of healthcare with innovative technologies, legal expertise, and focused, flexible customer service. The Phia Group is an experienced provider of healthcare cost containment techniques, offering comprehensive recovery, plan document, and consulting services designed to control plan expenses and protect plan assets.
Valenz, formerly United Claim Solutions SIIA Member
Rob Gelb, Chief Revenue Officer
23048 North 15th Avenue
Phoenix, AZ 85027
Phone: (866) 762-4455
Email: rgelb@valenzhealth.com
Website: www.valenzhealth.com
To deliver the industry’s first complete health administrative ecosystem, Valenz™ brings together provider networks, care management, claims management and assurance services on a single source, end-to-end analytics platform. This fully integrated solution provides a smarter way to manage risks, lower per-employee healthcare costs, and improve quality of care.
WellRithms, Inc. SIIA Member
Anna Quarum, Chief Culture Officer
3718 South West Condor Avenue, Suite 100
Portland, OR 97239
Phone: (503) 421-4460
Email: aquarum@wellrithms.com
Website: www.wellrithms.com
WellRithms is a medical bill review and full-service cost containment company. We first review bills for errors, fraud, and abuse. Then, we incorporate proprietary and legally defensible repricing methodology to reconcile claims on a line-by-line basis. With decades of medical, legal, and technical expertise, WellRithms provides financial wellness using proven algorithms.