Take control of your company's healthcare spending

Save up to 30% off your healthcare spend with Reference Based Pricing from NaviClaim.

Is your budget being strained by healthcare costs?

Reference-Based Pricing can reduce healthcare costs by 30%.

Take charge of your healthcare expenses by gaining insight into service costs for your members and plan.

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What & Why

In your business you must charge a fair price, or customers wouldn’t buy from you and generally, that price is a function of your cost plus a margin. Don’t most businesses operate that way? …NOT hospitals and medical providers.

The most elusive thing to find in healthcare is a Hospital Charge Master. The bottom line is that hospital charges have very little correlation to the cost or purchasing or providing the services. Many hospitals or providers are charging markups of 500% – 1,000% or more, over what they will accept from Medicare.

COULD YOU GET AWAY WITH THAT?

Advantages of Referenced Based Pricing

No Network Limitation

With RBP programs you can go to any hospital or provider and we can reprice the claim to a fair reimbursement.

Lower Costs

By paying the hospital something that is closer to their cost, you save money. We actually see many health plans increase benefits to their employees over time with a Referenced Based Pricing Program.

The savings generated can be used to reduce co-pays, improve or maintain current benefit plans and avoid cost shifting health coverage cost increases to their employees.

Long Term Stability

When the cost/reimbursement for healthcare becomes predictable


  • Many employers realize a 30% savings under the RBP model and see increases that are significantly below Medical Inflation Trend.

  • Gives you complete perspective of how and where your healthcare dollars are being spent

  • Protects members and plan for over charges

  • Dedicated Member Support and Advocacy is only an email or phone call away and we protect your plan and members from balance billing with our partner law firm.


How It Works

The current reimbursement model is based on a percentage of grossly inflated changes. How do we know this? Every provider that accepts Medicare is required to report their actual cost for the services. So, we know what they will accept from Medicare and we know that your health plan is overpaying. That is why your costs continue to increase.

Here is what we do to make sure you are paying a fair price...

  • 1: Review Bill Charges

    Review the bill for appropriate charges and reprice the claims to a reasonable mark up above what the provider accepts from Medicare every day.

  • 2: Fair Reimbursement

    We apply the methodology to create a fair reimbursement to the provider that pays for the actual cost of the service plus a significant margin.

  • 3: Send Claim & Process Bill

    We send the claim to your third-party administrator (TPA) to process your bill.

Ready to cut your
healthcare spending?

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