Reference Based Pricing Tool
Innovate360
Payer Compass helps the self-funded community, like TPAs, brokers, and employers, dramatically lower costs by better understanding the true cost of care. Our exclusive Reference Based Pricing (RBP) solution goes beyond cost containment, using a Medicare percentage to reveal the actual healthcare cost, and addressing providers in a manner that gains trust and acceptance of the reimbursement rate. Benefits for the plan and its members are tenfold as their faith in healthcare is restored through our sustainable alternative to traditional networks.
- Direct Contracts & Carve-Outs
- Safe Harbor Providers Access
- Balance Billing Avoidance & Support
- Reporting & Data Analytics
Benefits of Innovate360’s Medicare Reference Based Pricing Model
Single-Source RBP Program
Our comprehensive program provides the price visibility your clients need to control plan costs, lower employee out-of-pocket costs, and avoid balance bills, all while giving employees the freedom to choose any healthcare provider.
Price Transparency and Defensible Reimbursement
Claims are priced with ‘to the penny’ accuracy and come with a one-of-a-kind Process Trail that walks through how the reimbursement rate was figured. This makes it easier for providers to understand and accept the plan’s payment. No one likes surprise billing. With Innovate360, 98.4% of all claims are accepted by providers as paid.
Member Centered Patient Advocacy
Our patient advocacy services include working to gain provider acceptance, providing employees with care coordination, and maintaining a convenient Safe Harbor Provider list to help employees find RBP-friendly physicians and facilities. Our top priority is a positive patient experience along the journey of care.
Plan Empowerment and Education Services
True marketplace differentiation means protecting the plan and its members. Best practices are applied throughout the program – securing the plan upfront and defending balance bills with fiduciary and appeals services, plus legal defense. New ideas thrive with adoption. To set your RBP plan up for success, we provide education resources and 1:1 assistance for plan members and even providers.
Reliable Cost Forecasting
Our set Per Employee Per Month (PEPM) model delivers dramatic savings over often used percent of billed charges payment models, making it not only more affordable but easier to predict costs and stick to your budget. Employers save up to 25% more than network plans and stop-loss premiums are lowered 10 – 20% more than other solutions because the program’s fee structure has no impact on claims funds or stop loss payments.
Renewals, Retention, Growth
Using our scalable approach, we meet your groups where they are and customize as needed – Direct Contracting, Narrow Networks, Single-Case Agreements, Transplants, and other specialty cases. Groups only pay fair market value for the care received with our RBP model. That satisfaction optimizes costs and improves benefits. Further demonstrate that value with optimized data reporting.
