From a claims file to a carve-out plan.
EmClaim does one thing well: it measures what your plan pays against Medicare, line by line, and turns that into a short list of actions worth taking.
You share de-identified claims
Federal transparency rules entitle you to your plan's de-identified claims data and let you share it with an advisor. You send a de-identified extract — no names, no dates of birth, no member IDs. As a safeguard, EmClaim re-scrubs the file on the way in.
Every line is matched to the right Medicare schedule
Professional services price against the Physician Fee Schedule; hospital outpatient against OPPS; surgery-center claims against the ASC schedule. Each rate is adjusted for the service location, so the benchmark reflects your geography.
Each line becomes a percent of Medicare
A surgery paid at 318% of Medicare and one paid at 142% are no longer buried in a spreadsheet of thousands of lines — they're ranked by the dollars they cost you.
You get a carve-out map
The report names the procedures and facilities driving overpayment, compares the same procedure across sites of care, and models what steering volume — or a direct contract — would save.
Same procedure. Very different price.
The clearest savings usually aren't hidden — they're a knee replacement that costs three times more at the hospital than at the surgery center across town.
EmClaim surfaces that comparison directly and quantifies it, so a carve-out decision rests on your own numbers rather than a hunch.
No PHI on our servers.
EmClaim never needs patient identities to benchmark a price. The data class you're entitled to share is de-identified, and that's all the tool accepts.
- Benchmarking a CPT against Medicare needs the code, modifiers, place of service, and dollars — not a name.
- Uploads are re-scrubbed on ingest; identifying fields are stripped or rejected before anything is stored.
- No re-identification, no token maps, no patient-level identifiers kept.
EmClaim models opportunities from your data and public Medicare rates. It is decision-support, not a guarantee of savings, and not legal or actuarial advice.
See it on your own data.
Early partners get the first look as EmClaim comes online.