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THE CPN DIFFERENCE

Discover the Power of Going Direct

CLEARPRICE NETWORKS MODEL

CPN’s Transparent Business Model

Simple

Efficient

Less Expensive

01

Referral & Treatment

  • Authorized Referral Received from Payer

  • CPN Network Provider Identified and Matched to Patients Need

  • Medical Services and/or Equipment Provided to Patient

  • Confirmation of Service 

02

Billing & Repricing

  • CPN Network Provider Sends Bill to Payer

  • Payers Bill Review Service Reprices Bill to State Fee Schedule (SFS) And Sends Data to CPN Via EDI
    CPN Performs Fraud Check, SFS Audit, Coding Check and Reprices Bill to CPN Contract Rate and Returns Bill

  • Payers Bill Review Service Sends Payment Data to Payer

03

Provider Payment

  • Payer Follows Payment Instructions from Bill Review Service, Pays CPN Provider Directly Including Explanation of Review (EOR)

  • EOR Details Payment to CPN Provider

  • Payer Pays CPN Fee

VS

THE REBILLING MODEL

Rebilling Vendor's Opaque Business Model

Complex

Innefficient

More Expensive

01

Referral & Treatment

  • Authorized Referral Received from Payer

  • Rebilling Vendor Network Provider Identified and Matched to Patients Need

  • Medical Services and/or Equipment Provided to Patient by Rendering Service Provider (RSP)

  • Confirmation of Service Completion Provided to Payer

02

Rebilling Process

  • Rendering Service Provider (RSP) Sends Bill to Rebilling Vendor or Payer 

  • If RSP Bill Sent to Rebilling Vendor, New Bill is Created by Rebilling Vendor with Rebilling TIN and 30% To 50% Markup Applied to Rebilling Vendor Contract Rate with RSP

  • If Bill Sent to Payer, Payers Bill Review Service Must Identify Bill, Freeze It in System, and Send Image to Rebilling Vendor to Produce a New Bill with Rebilling 

03

Billing & Repricing

  • Rebilling Vendor Sends New Bill to Payer’s Bill Review Service.

  • Bill Review Service “Kills” Original Bill and Reprices Rebilling Vendor Bill to State Fee Schedule (SFS) and then Rebilling Vendor Rate with Payer (at Slight Discount)

04

Rebilling Vendor Payment

  • Payer Follows Payment Instructions from Bill Review Service, Pays Rebilling Vendor Directly Including Explanation of Review (EOR)

  • EOR Details Payment to Rebilling

05

Rendering Service Provider Payment

  • Rebilling Vendor Receives Payment, then Pays Rendering Service Provider 30-60 Days Later

NO REBILLING =

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Payer Savings of 20% below Rebilling Company Charges

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Improved Reimbursement for Providers

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Direct Relationships between Payers and Providers

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Transparent Billing, Pricing and Payment

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Streamlined Authorization and Approval Pathways

STRATEGIC PARTNERS

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