Reference Based Pricing is a No-Network, all providers and facilities are available nationwide, solution. Provider pricing (established by Medicare) creates a base price representing true cost = 100%. Out of network cost is as high as 16,000% of Medicare. PPO’s are typically set at 225%.
When your network provider or insurance company negotiates a lower settlement, something below 225%, who gets the difference? Not You!
Do you need a PPO/Network? Not necessarily. Look at all the new plans entering the market today, narrow network designs combined with a reference based solution. Do you need claim auditing? Absolutely! Included in our solution.
There are significant shortcomings with the most reference-based pricing vendors. Only a handful “Do it Right.” Veridence 365 has a fully vetted, best solution vendor in the country, delivering a working fair pricing healthcare payment model. Veridence 365 deliverable is a comprehensive A to Z solution for Self-Insured Employers and Third Party Administrators—getting it right the first time & saving up to 35%!