Health Payer Consortium

Health Payer Consortium (HPC) is a cost containment company headquartered in St. Louis, MO, focused on one measurable outcome: reducing annual claims expense for health plans and the organizations that support them. Founded in 2014 by industry veterans who have established and managed some of the largest companies in the self-insured space, HPC takes a client-first approach that means every solution is built around the client's existing workflow, not the other way around. The result is a back-office outsourcing partnership that delivers documented savings without disrupting how your team operates. HPC's core offering is Medical Bill Review, which averages a 15% reduction from annual billed charges by identifying invalid and non-compliant charges before any network contract is applied. Reviews are performed by clinicians and coding experts who audit claims against the Social Security Act, the False Claims Act, CMS manuals, state laws, and national AMA and AHA billing guidelines. The output is clean claims that hold up against plan documents and PPO contracts, producing a verifiable reduction in overall plan cost. For high-acuity cases, the HPC Advantage program mines precertification, case management, and other reports to flag high-risk claims and match them to specialty network contracts or centers of excellence. Coverage includes CAR-T therapy, transplant review, oncology (with contracts at Cancer Treatment Centers of America), dialysis, hemophilia factor replacement, LVAD implants, and congenital heart defects. When a case does not fit within an existing specialty contract, HPC closes the gap through direct negotiation and bill review so that no savings opportunity goes unaddressed. HPC also provides advanced claim editing technology for institutional and professional claims, delivered as a cloud-based SaaS, web service, or EDI solution that accepts files in nearly any format. Rules and logic are refreshed weekly and can be customized by group, provider, code set, or geography. Out-of-network claims are handled by a dedicated negotiation team that escalates to compliance audits when a fair price cannot be reached through standard negotiation. Reference-based pricing solutions round out the service menu, including fully automated Medicare-based pricing, multi-vendor RBP management, and turn-key implementations that include group and employee training. HPC works with Third Party Administrators, Health Plans, Managing General Underwriters, Stop Loss carriers, Reinsurers, and Brokers in the commercial and self-insured healthcare market. If your organization is looking for a healthcare BPO company in the USA with hands-on expertise in claims cost containment, contact Health Payer Consortium directly to discuss how their outsourcing approach can lower your annual claims spend.