6 Degrees Health

Reference Based Pricing and Payment Integrity


What is 6 Degrees Health?

Thanks, Chris. 6 Degrees Health is a cost containment company with a mission to help employers and health plans take back control of their medical claim costs. This is accomplished through a combination of clinical review and structured provider payments tied to objective benchmarks like provider costs and Medicare reimbursement. With 6 Degrees' transparency data, employers are realizing that the status quo, traditional networks are binding them to contracts that permit unreasonable provider billing practices. These all too common billing practices drive unsustainable employer medical claim and stop-loss cost trends. Our core network replacement solution routinely cuts employers' overall healthcare spend by 20% to 40% when compared to traditional network models. We also service plans that utilize our reference based pricing solution as an out of network tool to bookend direct and primary network contracts, as opposed to running low discount wrap or supplemental networks. Furthermore, regional and national carrier based plans also utilize our clinical billing review solution on a standalone basis.

How is 6 Degrees Health different?

One of our big differentiators for 6 Degrees is our large claim pre-payment solution powered by an industry-leading clinical review team. Whether you're repricing claims to a Medicare multiple or to a direct, or network contract, if you don't have experienced clinicians reviewing and correcting these claims prior to adjudication then you're overpaying. Medical billing errors are not the exception, they are the norm. This clinical review program is not only an integral part of our reference based pricing strategy, but also a standalone product utilized by network-based regional and national carriers.

Who is a good fit for 6 Degrees Health?

6 Degrees services every size plan, from reference based pricing for small level funded plans to thousand plus employee groups. In addition to self-funded employers, our clinical review team also services regional health plans on up to national carriers. We commonly work closely with both plans and their channel partner consultants, TPAs, stop-loss carriers, and medical management.

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Duration: 02:39

Posted: Friday, June 16, 2023

Video tags: Under 50 EEs, 51 - 100 EEs, 101 - 250 EEs, 251 - 500 EEs, 501 - 1000 EEs, 1001 - 2500 EEs, 2501 - 5000 EEs, Over 5000 EEs