Reference-Based Pricing Solutions

Fair Reimbursement

Data-Driven

Man with a beard and glasses looking at and engaging with a tablet he holds

Aim to reduce costs, enable engagement, and address pricing gaps with data-driven RBP solutions.

In an environment in which healthcare prices are often opaque, having a partner that can bring clarity to costs can make all the difference — especially when it comes to making healthcare affordable.
 
Our reference-based pricing (RBP) services offer flexible, cost-effective, data-driven solutions aimed at reducing healthcare costs.

Reference-based pricing solutions and services designed to reduce balance billing, manage costs, and empower members.

Data iSight®

Data iSight®

Our alternative to U&C or Medicare-based reimbursement recommendations for out-of-network (OON) charges that delivers consistent, transparent results with high provider acceptance.

Medicare

Medicare-Based Pricing

Claritev’s Medicare-Based Pricing service combines Medicare benchmarks with publicly available claim data to deliver fair, transparent, and defensible reimbursement — filling Medicare pricing gaps with confidence and consistency.

Vistara™

Vistara™

A single solution that either exclusively offers reference-based pricing for facility and professional claims or integrates the PHCS Network and reference-based pricing to deliver transparency, insight, and access aimed at reducing the cost of care for employers and their members.

Pro Pricer®

Pro Pricer®

Claritev’s data-driven, configurable solution that brings clarity to out-of-network cost management programs to enable savings.

  • The things we value most about our partnership with Claritev are not just the reliable, efficient delivery of savings through their MSP and ESRD services, but the fact that they are always willing to come to the table to discuss and collaborate on new and innovative solutions that nobody else in the industry has yet to try.

    Drew Satriano, VP of Payment Integrity

    Highmark, Inc.

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    During an EHR transition, the biggest risk often isn’t the future-state platform—it’s the current-state environment that continues to power patient care, clinical workflows, revenue…

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Pattern

Reach out to learn how our solutions can go beyond reducing costs and increasing transparency by enabling affordable care for all.