The startup provides a healthcare network system that connects payers and providers through electronic transactions, enhancing transparency and efficiency in the payment process. By leveraging detailed insights into provider networks and billing practices, the system enables payers to reduce costs while ensuring healthcare providers receive timely and accurate payments.
Funding
$750K raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
Founders
Product
Problem
Traditional healthcare payment systems often involve intermediaries that add markups and inefficiencies to the billing process. This can lead to inflated costs for payers and delayed or reduced reimbursements for healthcare providers, particularly in areas like durable medical equipment (DME), orthotics, prosthetics, and home care services.
Solution
ClearPrice Networks (CPN) directly connects payers and providers through a transparent, electronic transaction system that eliminates rebilling middlemen and their associated markups. The CPN program facilitates direct billing and payment, ensuring that providers receive improved reimbursement while payers benefit from savings of 20% or more compared to rebilling company charges. By establishing direct relationships and transparent pricing, CPN streamlines authorization and approval pathways, reduces administrative costs, and promotes efficient payment processing within a network of licensed and credentialed providers. The platform also offers out-of-network solutions, including referential pricing and single case agreements, to maximize savings.
Target Audience
CPN primarily serves workers' compensation payers and healthcare providers specializing in DME, orthotics, prosthetics, medical supplies, and home care services.
Features
- Direct billing and payment between payers and providers, eliminating intermediary markups
- Prospective and retrospective bill repricing using CPN's pricing platform
- A national specialty network of over 4,800 provider locations
- Referential pricing recommendations based on an extensive database of healthcare cost and payment data
- Single case agreements (SCAs) for out-of-network services at comparable rates
- Integration with bill review partners via EDI repricing bridges
- Fraud checks, coding audits, and state fee schedule audits on every bill
- Transparent fee structure with clear, concise rate tables compliant with state and federal guidelines