Know what your plan pays — and where it overpays.
EmClaim benchmarks every line your self-funded health plan pays against Medicare, then shows you exactly what to carve out.
EmClaim is in active development. Figures shown are illustrative.
You carry the risk. You can't see the price.
If you self-fund, every dollar of claims is yours. Yet the people who administer your plan rarely show you what a procedure should cost — or what they paid for it.
You hold the cost
Self-funded plans pay claims directly. The financial risk sits with you, not the carrier.
The price is opaque
Invoices and summaries rarely tell you what a service cost relative to any fair reference.
The spread is hidden
Repricer and "shared savings" arrangements can sit between the claim and what you're billed.
One honest yardstick: Medicare.
EmClaim takes your de-identified claims and measures every line against the Medicare allowed amount — the closest thing to a neutral reference price the market has.
Benchmark every line
Professional, hospital outpatient, and ambulatory surgery claims are each priced against the right Medicare fee schedule, adjusted for your geography, and expressed as a simple percent of Medicare.
Surface the overpayments
See which procedures and facilities run at multiples of Medicare — sorted by the dollars at stake, not by claim count.
Rank the carve-outs
The same procedure can cost three times as much at a hospital as at a surgery center. EmClaim models the savings of steering volume to the lower-cost site, or a direct contract.
Three steps, no PHI on our servers.
Bring your de-identified claims
Federal transparency rules now entitle you to your plan's de-identified claims data — and let you share it with an advisor. That file is all EmClaim needs.
We benchmark it against Medicare
Every line is priced against the matching Medicare schedule and returned as a percent of Medicare. No patient identities required, ever.
You get a carve-out map
A clear report of where the plan overpays and which procedures are worth carving out first — with the modeled savings for each.
EmClaim models opportunities from your data and public Medicare rates. It is a decision-support tool, not a guarantee of savings or a substitute for legal or actuarial advice.
See it for yourself.
Explore the live demo on sample data — the real benchmark engine, no signup. Then request early access to run it on your own plan's claims.