Products / Specialty / Reference-Based Pricing Networks
ClaimDOC
Public factsReference-based pricing (DirectAccess+)
ClaimDOC’s DirectAccess+ is a reference-based pricing program for self-funded plans that prices claims against disclosed commercial-contract data and member advocacy.
Overview
ClaimDOC, LLC sells DirectAccess+®, a reference-based pricing model for self-funded medical plans. Public pages say the company pays claims in all 50 states and that plans save an average of 25–35% versus traditional plans, with clients that switch saving 33% in the first year on average. Claim-level case studies compare a DirectAccess+ allowable to a Turquoise Health median commercially contracted price. ClaimDOC is not a carrier; it is a pricing and advocacy vendor used with a TPA and stop-loss.
Why it matters ClaimDOC is a dedicated RBP brand (DirectAccess+) with published claim-level PPO-vs-RBP comparisons, not a silent PPO wrap.
- Target buyer
- Self-funded employers, brokers, TPAs, and stop-loss partners evaluating a primary RBP replacement for a PPO.
- Pricing model
- Not published; custom RBP quote
- Vendor-stated averages: 25–35% vs traditional plans; 33% first-year savings for clients that switch. Case-study allowables are claim-specific, not a fee schedule.
- Availability
- National
- Research
- Last researched 2026-08-23
- Public facts category
Key features
- DirectAccess+ reference-based pricing
- Claims paid in all 50 states (vendor-stated)
- Line-by-line claim auditing by licensed healthcare professionals
- Savings comparisons using Turquoise Health median commercial contract prices
- Member advocacy and 360° View Of Risk framing (member, employer, stop-loss)
- Published employer case (Mittera replaced a traditional PPO with ClaimDOC RBP)
Overview
ClaimDOC positions DirectAccess+ as a full-plan reference-based pricing alternative to a traditional PPO. The homepage describes transparent medical claim pricing, a “360° View Of Risk™” across member, employer, and stop-loss, and average plan savings of 25–35% versus traditional plans. The gold-standard / broker page adds that clients that switch save 33% in the first year on average and that ClaimDOC pays claims in all 50 states.
Published news items walk through individual hospital stays (for example NICU and sepsis cases) and compare a “traditional network” allowed amount—defined as the Turquoise Health median commercially contracted price—to the ClaimDOC allowable, then apply sample 20% coinsurance.
Key Capabilities
- DirectAccess+ RBP pricing for self-funded medical claims.
- Line-by-line auditing by licensed healthcare professionals (case-study language).
- Commercial-contract benchmarking via Turquoise Health median prices in public savings examples.
- Member advocacy and risk framing that explicitly includes stop-loss carriers.
- Named employer example: Mittera (print/marketing company, 20-state footprint) replaced a PPO with ClaimDOC RBP.
Integrations & Ecosystem
No public TPA or clearinghouse connector list. Buyer pages exist for members, employers, providers, brokers, and stop-loss. Implementation assumes a self-funded stack (TPA + stop-loss + PBM) around DirectAccess+.
Pricing
Not published. Outcome averages (25–35%, 33% year one) are vendor-stated. Individual case studies show plan and member dollar savings on specific bills; they are not a rate card.
Notes & Limitations
- Savings averages and case studies are company-selected examples.
- Traditional-network comparators in the case studies are median commercial contract prices, not a specific client’s prior PPO schedule.
- ClaimDOC is a pricing/advocacy vendor, not an insurer.
Sources
Tags: RBP · DirectAccess+ · self-funded · claim audit