Leading the Charge for Reimbursement Accountability

What is INNOVATE360?

We’re transforming the way cost containment is done. Experience significant healthcare claim savings of 65% or more and plan member satisfaction through a single, proven source that brings together healthcare claim pricing accuracy, patient-centric advocacy, and end-to-end balance bill strategy. INNOVATE360 is the smarter way to do business for payers.

Reference-Based Pricing (RBP) seeks to provide the true cost of care administered by a healthcare provider or facility, replacing the antiquated percent off billed charges that are based on an ambiguous chargemaster or even published fee schedules that still beg the question of the source(s) for the arrived procedural prices. Approaches to RBP differ based on the parties involved – TPA, Benefits Advisor, Stop-Loss Carrier, RBP vendor,
Employer – and their preferences. Payer Compass’s turnkey RBP program, INNOVATE360, focuses on three pillars: 1. accurate claim pricing, 2. proactive patient advocacy, and 3. effective balance billing strategy.

Who Benefits From a Turnkey Reference-Based Pricing Program?

TPAs, Self-Insured and Brokers

Reap the rewards from a truly Best-in-Class program. With operations simplified, thorough caring member support administered and plan savings achieved, INNOVATE360 is the PPO replacement program of choice.

Health Plans

In addition to sharing the benefits for TPAs and the Self-Insured communities, we can support your plan goals through our expanded programs. With over 26 years in the medical risk industry, our Case and Disease Management services have worked in tandem with Plans to offset heightened claim costs through determination of the appropriate care and ongoing plan member support and maintenance.

Stop-Loss Carriers

Financial reserves remain intact for your self-funded clients with our high-performance cost containment program. Of specific interest to you is the program’s modeling and analytics capabilities, including all of the features of our BENCHMARK tool so that you can advise your clients on optimal
policy decisions.

Experience the Difference

A Proactive Approach to Healthcare Cost Containment that Benefits Everyone

Turnkey Program
Improve efficiencies and coordination with the advantage of one comprehensive source

Work Smarter, Not Harder
Upfront document review and alignment puts you in a position for reimbursement success

Optimal Outcomes
Gain confidence in a partner that delivers less than 1% of processed claims resulting in balance bills

Freedom of Choice
Offer quality care without network restrictions - plan members have the freedom to choose any provider or facility!

Optimize Savings
Gain control of healthcare spend and better manage plan costs with a competitively-priced subscription model

Operate With Integrity
Unlike similar market programs, we do not practice a “Scorched-Earth” version of cost containment. We understand the importance of long-term relationships between payers and providers, addressing outstanding claim balances in a less abrasive manner.

Positive Member Experience
We build and maintain Safe Harbor provider lists, expediting the connection between member and provider/facility

Educate and Engage
Helpful plan education and marketing support materials make for a smoother transition to your new RBP plan

Extend Your Reach
Our Care Management and Disease Management programs integrate seamlessly to enhance your plan and member care