Unlocking Cost Savings with Reference Based Pricing (RBP) - ClaimDOC - Omar Arif

This week I sit down with Omar Arif, SVP of Growth with ClaimDoc to answer the question, "What is Reference Based Pricing, aka "RBP"?"

Omar Arif, the SVP of Growth for Claim Doc, a cost containment vendor, was sold on RBP when he discovered it. Claim Doc provides a balanced approach to RBP, combining both "pay and defend" and "negotiate and settle strategies".

Omar states that their network replacement is the most buttoned up in the industry, with all legal work, provider relations, and member services done in-house. The give and take of pay and defend vs. negotiate and settle is up to the individual to decide.

Claim Doc's clinical team of nurses and coding experts performs a clinical audit on every single bill before re-pricing the claim. They also cap themselves out per claim to avoid being egregious and to be more friendly to stop loss markets.

Stop loss carriers that have taken the time to learn ClaimDoc's model and have experience with them will often offer lower stop loss rates. Claim Doc is also transparent about how they get paid, taking a percentage of the build charge.

Claim Doc is a family owned boutique company that is not the norm in the healthcare reimbursement space, which is mostly private equity or venture capital backed firms. They have 120 employees, with half of them being member facing to ensure access to care outside of a traditional contract and handle any billing questions.

Why are so many people switching to ClaimDoc?

It is because they say "They're working to make your self-funded insurance plan remarkable. Using next-generation technology paired with a human touch, they deliver transparent medical claim pricing and allow our clients' health plans to thrive."

Links:

Self Funded on YouTube: https://www.youtube.com/c/SpencerSmithSelfFunded/videos?app=desktop

Self Funded With Spencer (Audio Version): https://podcasters.spotify.com/pod/show/spencer-harlan-smith

ClaimDoc Website - https://claim-doc.com/

ClaimDoc LinkedIn Page - https://www.linkedin.com/company/claimdoc/

Omar Arif LinkedIn Page - https://www.linkedin.com/in/omararif1/

Timestamps:

5:00 - Lamborghini Dreams

7:45 - Playing Pro Baseball

14:56 - Getting Hooked On Sales

21:30 - What Is An RBP?

35:23 - RBP Implementation

41:11- Employer Communication

47:41 - Medicare As A Reference Point

54:10 - Will RBP Ever Become The Norm?

59:06 - Conclusion

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