Specialty / Reference-Based Pricing Networks

RBP, out-of-network, transplant/specialty, and payment-integrity vendor using the MediVI analytics platform and MediShield legal support.

Advanced Medical Pricing Solutions (AMPS) sells PriceDynamix claim repricing, ClaimInsight payment integrity, and Drexi PBM to self-funded employers, TPAs, and payors.

Self-funded plan and curated PCP-centered network for employers of about 50–3,000 employees, with $0 primary care and optional PPO or RBP alongside the Centivo network.

ClaimDOC’s DirectAccess+ is a reference-based pricing program for self-funded plans that prices claims against disclosed commercial-contract data and member advocacy.

Seattle-based, physician- and hospital-owned independent PPO used by self-funded employers, TPAs, and carriers, with medical management, EAP, and health-plan administration.

MultiPlan’s national PPO and specialty networks now sit under Claritev (rebrand announced February 17, 2025); used by carriers, TPAs, and self-insured employers.

Former independent RBP and claims-pricing company (Visium SaaS) acquired by Zelis in 2022; payercompass.com now redirects to Zelis.

Rental PPO and Renovo pricing technology for workers’ compensation, group health, corrections, Medicare Advantage, and auto casualty.

Not-for-profit, employer-owned Midwest cooperative that contracts Smarter Networks and Reference-based Contracting for self-funded employers.

Cost-containment firm offering Care Empowered Pricing (RBP), Phia Unwrapped OON repricing, plan-document language, NSA/IDR, subrogation, and PACE fiduciary appeals.

TRPN DirectPay rental network for group health, workers’ compensation, and auto liability; trpnppo.com returned HTTP 500 at research, so current public facts are from trpndirectpay.com.

Healthcare payments and pricing platform for payers and TPAs, including network design, claims pricing, Open Access Pricing RBP, and provider payments.