In response to the increasing self-funded market interest In Medicare reference-pricing plans, CareValent, a Payer Compass Company, has developed a rigorous Patient Advocacy program to support members of these plans.

We designed the program to educate both employees and providers about unique self-funded plan challenges and the rationale behind employers moving to Medicare reference-pricing plan designs.

Our offerings include a full service advocacy and support system to serve all stakeholders: third-party administrators (TPAs), employers, plan administrators, brokers, patients, and providers.

CareValent has extensive experience with managing Medicare reference-based pricing Patient Advocacy programs. We are ahead of the industry in establishing a successful track record in dealing with member and provider questions and issue resolution.


It's our belief and practice to take a proactive approach to Patient Advocacy. We recommend that all plans considering a Medicare reference-based pricing plan design implement a Patient Advocacy program to assist and support TPAs, plan administrators, employers and their members, and providers. To be most effective, plans should make Patient Advocacy services available at the time a plan change is announced and continue throughout the program term.

Program Highlights:

Member Liaison:

  • Educates members about Medicare reference-based pricing

  • Refers members to an accepting provider and performs outreach to members' providers, and

  • Supports members during plan transition and beyond

Provider Liaison:

  • Educates providers about Medicare reference-based pricing and encourage acceptance

  • Provides support and guidance for accepting providers, and

  • Communicates group plan information to providers

Balance Bill Support:

  • Coordinates with TPAs 

  • Performs outreach to providers for reimbursement acceptance

  • Keeps members updated on status, and

  • Negotiates with providers at a client's request

Client Liaison:

  • Includes an integrated Patient Advocacy system with a client portal

  • Provides clients with member education materials

  • Maintains a safe-harbor list of accepting providers

  • Provides detailed, ongoing reporting, and

  • Provides continued support and guidance


(877) 810-9939

(727) 499-0965


Payer Compass Patient Advocacy & Case Management

360 Central Avenue, Suite 440, St. Petersburg, FL 33701

©2016 by CareValent