Open-access care, supported by reference-based pricing (RBP), improves the member experience and provides more cost-effective coverage.
Member advocacy
Claim audited
IDR success rate
Imagine360’s network alternative solution for health plans wraps around an existing network or service area to provide excellent coverage, deliver a coordinated member experience, and drive enhanced savings through our proprietary reference-based pricing (RBP) solution.
Reprice claims using our RBP solution — we don’t just use the qualified payment amount (QPA) — to deliver consistent, fair pricing.
Address No Surprises Act (NSA)-eligible claims with our proven cost-containment model.
Utilize 30M+ member months of RBP data and predictive analytics to reduce member disruption while preserving plan savings.
Equip members with data and tools to identify best-fit options. Or they can call Member Services for help.
Support members at every step of their healthcare journey with one number to call and one-to-one support for the life of the claim.
Offer flexibility to customize the configuration that best fits needs — not a one-size-fits-all model.
Health plans can leverage Imagine360’s nearly two decades of experience with reference-based pricing (RBP) as an extension to their contracted network or as a network replacement for rental arrangements they have set up outside their service area.
Transform one of the biggest cost blind spots in your health plan.
When care happens outside your proprietary network, our out-of-network solution uses fair, transparent pricing and expert advocacy to reduce surprise bills, protect members, and help control spend.
Ensure seamless coverage for members who live, work, or travel outside your core service region.
Our out‑of‑area solution delivers seamless nationwide access and average savings of approximately 70%, without the need to rent network access from third-party providers.
By using Imagine360’s solutions, regional health plans can better compete for geographically dispersed employers by creating differentiation where national carriers fall short.
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National PPO Wrap
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Imagine360’s wraparound solution layers around an existing network or service area to address out‑of‑network and out‑of‑area care without replacing what’s already in place. It combines open‑access care with Imagine360’s reference‑based pricing (RBP) solution to preserve coverage, support members, and drive enhanced savings for health plans.
Unlike national PPO wraps that rely on rented network contracts with limited flexibility, Imagine360 uses open access to care supported by reference‑based pricing (RBP). This approach eliminates dependency on provider directories and rented network agreements and gives health plans more control over pricing, claims administration and member experience.
No. Imagine360’s wraparound solution is designed to work alongside an existing network. Health plans can continue using their contracted networks while relying on Imagine360 to address out‑of‑network and out‑of‑area coverage gaps or replace rented network arrangements where appropriate.
Reference‑based pricing (RBP) establishes fair, data‑driven reimbursement when no contracted rate exists. Imagine360’s RBP solution helps health plans maintain pricing discipline, reduce overpayments, and support compliance with the No Surprises Act (NSA) while expanding access beyond their networks.
Members receive one‑to‑one support throughout the life of the claim, with one number to call for assistance. Imagine360 helps members navigate care, billing, and provider communication, reducing confusion for members and disruption for health plans.
Out-of-network care refers to services provided by a healthcare provider or facility that does not have a contracted agreement with your health plan. Because there is no negotiated rate in place, out-of-network care typically costs more for both the plan and the member.
Out-of-area coverage refers to care received outside a health plan’s primary geographic region. This often affects members who live, work, travel, or maintain secondary residences in locations where the plan’s core network is not available.
The No Surprises Act (NSA) is a federal law designed to protect patients from unexpected medical bills – especially when they unknowingly receive care from out-of-network providers or facilities. The law went into effect on January 1, 2022, and applies to emergency services, certain non-emergency services delivered at in-network facilities, and air ambulance services.
Under the No Surprises Act (NSA), Independent Dispute Resolution (IDR) is the federally mandated process for resolving payment disputes between health plans and out-of-network providers when the parties cannot agree on an appropriate reimbursement amount for certain services.
