Intelligent Health Marketplace Directory

Explore the range of Health Market participants serving Payers on the MacroHealth Intelligent Exchange™ marketplace. Identify categories to optimize your healthcare spending or enhance your offerings, and learn about the companies available in each optimization.

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6 Degrees Health  

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

6 Degrees Health  

6 Degrees Health is a healthcare cost containment company focused on superior results and customer experience. We use clinical expertise and technology to ensure fair reimbursements and improve payment accuracy.   

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Ceris

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

Ceris

As a leader in claim reviews, CERIS uses clinical expertise to ensure accuracy in healthcare payments. With over 30 years of experience in Prepay, its universal chargemaster contains items from over 97% of the nation’s hospitals, ensuring accuracy and an objective claim review. 

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ClearHealth Strategies

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

ClearHealth Strategies

ClearHealth Strategies offers top technology and services for reference-based pricing, out-of-network, supplemental network and surprise billing programs with a turnkey approach to manage profile building, claim pricing, balance billing, hold harmless, and arbitration (IDR) processes. 

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CMSPricer

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

CMSPricer

CMSPricer is a Medicare pricing/editing and Contract Manager technology solutions company. Our Contract Manager solution easily loads all network contracts and processes all claim types based on both Medicare and non-Medicare fee schedules. 

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FairCost

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

FairCost

FairCost helps control the cost of out-of-network medical claims. Our services cover the full spectrum of out-of-network claims. Learn more about our products: FairCost QPA Assist™ and FairCost Optimizer™.

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First Health

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

First Health

First Health® provides national and regional Preferred Provider Organization (PPO) network access and other cost containment programs to help our clients manage employee benefit plans. For example, the First Health Network is one of the largest directly contracted networks.

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Networks By Design

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

Networks By Design

Networks By Design is the leading California client-customized PPO/EPO network company. We have the network development expertise and treatment data information to design client specific Group Health medical networks.  These client- tailored networks meet the needs of each individual employer client. We are not the typical “large commodity PPO network” using outdated demographic information and covering excessive geography. We believe a one-size-network does not fit all!

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NovaNet

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

NovaNet

NovaNet is a PPO delivering network coverage with a distinct perspective, and it is not owned by physicians, hospitals or insurance carriers. This allows NovaNet to creatively collaborate with its clients to deliver the most effective products and services for members. 

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Plotkin Health

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

Plotkin Health

Plotkin Health is a medical cost containment company serving over 50 national & international health insurers. Specializing in all facets of medical loss mitigation, Plotkin Health is your trusted partner in fair, ethical and simple healthcare claim resolution.

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Unity Preferred Networks

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

Unity Preferred Networks

Unity Preferred Network specializes in Direct Contracting, ensuring cost savings without the headaches of RBP. Unity helps out TPAs and Health Plans optimize costs without friction and is here to be utilized in a Primary and Secondary manner, sitting in front of RBP for all of our clients to exhaust all of our resources to solve claims issues. 

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Valenz

Fee Negotiation

NSA/QPA

Out of Network 

Payment Integrity 

Provider Contract Repricing/Contract Management 

Provider Network

Specialty PBM 

Valenz

Valenz Health is the platform to simplify healthcare – the destination for employers, Payers, providers, and members to reduce costs, improve quality, and elevate the healthcare experience. Valenz engages early and often for smarter, better, faster healthcare.  

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