Medicare Reference Based Pricing Approach Gains Momentum

In 2010, NUS introduced the underwriting platform and components required for our TPAs and Employer Plans to use Medicare Reference Based Pricing (MRBP) for the payment of claims. This approach is based on the elimination of the need for network contracts, alleviating the confusion of PPO issues and ineffective discounts.

NUS formed strategic alliances for our TPAs and their clients to be able to successfully implement this approach. Service providers utilize customized solutions for a multitude of pro-active services including re-pricing claims, participant and provider advocacy, a tailored Plan Document and pushback support. Savings reported to date through 2014 on in force plans are substantial, enabling excellent underwriting results and pricing of stop loss coverage. Provider acceptance has been very favorable and has in many cases led to TPAs facilitating direct hospital contracts for MRBP.

For detailed information contact Dana Driscoll, Executive Vice President at ddriscoll@nus1.com or direct number: 210-695-2381, ext. 202.