ClaimDOC

10/15/2026

Plenty of reference-based pricing programs promise provider access. DirectAccess+ proves it.

At this point in 2025, we had processed just over 13,000 provider nominations for the year and delivered a 96.5% participation rate.

This year, we've processed nearly 20,000 more nominations, and there's been no drop in participation. That’s what proven provider access looks like.

10/13/2026

Six days in the hospital. Multiple serious diagnoses. And under a traditional health plan, the cost would have been nearly twice as high for both the member and the plan.

Our auditors found the savings others leave sitting on the table. Because paying more for health care doesn’t make it better. It just makes it more expensive.

Visit our website to see more real savings examples from the past month.

With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. Using Turquoise Health to find the median commercially contracted price, we ...

10/12/2026

In true ClaimDOC style, we wrapped up Customer Service Week on Friday with a friendly competition!

From catered meals and a scavenger hunt to treat bags, chair massages and, finally, a minute-to-win-it contest, it was a fun week celebrating the people who do so much for our members and clients.

Thank you to our incredible team for everything you do!

10/08/2026

We don’t call it member advocacy because it looks good on paper. It's what we do.

When a health plan member describes their advocate as extended family after seven months of navigating health care billing issues together, that’s not just extraordinary customer service. It’s the ClaimDOC standard.

10/07/2026

The giants in the health insurance industry have their place. But bigger doesn’t mean better, and it doesn’t always make them the best partner for your health plan.

On our latest ClaimTalk, Shepherd Insurance President Jeff Kweder and Advisor Steve Goodin discuss the evolution of reference-based pricing and why successful ex*****on depends on partners who know the business, know the people and provide personalized service.

10/05/2026

It’s one of our favorite times of the year: Customer Service Week! While the work our team does to support our clients and their health plan members never goes unnoticed, we love an extra excuse to show our appreciation.

We have plenty planned for the team this week, starting with today’s catered lunch!

10/03/2026

It’s scary how great our team is! Big thanks to our October work anniversary crew. Our health plan members are frighteningly lucky to have you on their side.

10/02/2026

Undefeated. Relentless. Still climbing.

Jacobe "Cobe" Smith is on the rise in the Ultimate Fighting Championship and headed back to the octagon this Saturday with a perfect 12-0 record. ClaimDOC is proud to be in his corner.

We know what it's like to take on tough opponents. Every day, we fight to bring transparency and fair payment solutions to health plans — an effort that demands persistence, discipline and resilience. Those same qualities have helped fuel Cobe's success. We've been honored to sponsor his journey to becoming a UFC name, and we can't wait to see what's next.

Good luck this weekend, Cobe. We'll be cheering you on!

10/01/2026

Reference-based pricing didn’t earn acceptance overnight.

Early models delivered the kind of savings that got everyone’s attention, but they also created enough disruption to test everyone’s patience.

On this episode of ClaimTalk, Shepherd Insurance President Jeff Kweder and Shepherd Advisor Steven D. Goodin share war stories from their earliest RBP cases and explain how the model matured into a solution with service they can stand behind and are proud to offer their clients.

  Reference-based pricing has come a long way from its early days. While eye-popping savings got employers interested, RBP created enough disruption to make you wonder if the savings were worth the headaches. Then the model grew up. ...

09/30/2026

Sepsis is the costliest cause of hospitalization in the United States. Add complex coding, lengthy stays and hospital-acquired cases, and the opportunity for expensive errors only grows.

In her newest Audit Spotlight, Vice President of Audit Services Cynthia Swanson breaks down common sepsis coding pitfalls and examines a case with nearly $1.2 million in billed charges. Her team priced the claim 79% below the billed amount.

Read the article to see why claims this complex require auditors who know exactly what to look for.

Discover how the high cost of sepsis can impact health plans and why controlling costly medical claims matters for plan performance.