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Medical Cost Containment
Learn how our clients are transforming
Health Education Into a Compliant Medical Claim - Redefining Cost Containment
ResultMD partners with a licensed medical provider to route eligible preventive and member engagement services through the physician NPI, HCPC-S codes, and ICD-10 diagnostic codes, converting what was once an administrative fee into a structured, adjudication-ready medical claim.
Every service category we work with is clinically validated and documented prior to claim submission.
Every Claim: Fully Compliant
Built on clinical legitimacy, not workarounds.
100%
Compliant Claims
Day 1
Integration Ready
5–26%
Reduction in Plan Cost
Across self-funded and level-funded arrangements
100%
Claim Compliance Rate
Every claim fully coded and physician-documented
Multi-Market
Plan Compatibility
Self-funded, level-funded, PEO, and captive
Day 1
Integration Ready
Partners can present proposals immediately upon onboarding
The ResultMD Model
How Administrative Costs Become Medical Claims
By routing eligible services through our licensed medical provider, ResultMD creates a compliant medical claim event, shifting costs from an administrative fee line to a reimbursable medical claim.
Licensed Physician NPI
All services are credentialed under the National Provider Identifier (NPI) of our licensed medical doctor, establishing clinical legitimacy and payer acceptance.
HCPC-S Procedural Coding
Each eligible service is assigned the correct Healthcare Common Procedure Coding System (HCPC-S) code, ensuring proper claim structure and clean submission to the plan or payer.
ICD-10 Diagnostic Codes
Precise International Classification of Diseases (ICD-10) diagnostic codes are matched to each service, completing the clinical documentation required for medical claim adjudication.
Admin Fee to Medical Claim
The result is a paradigm shift: what was previously billed as a flat administrative fee is now structured as a legitimate medical claim, improving cost transparency, benchmarking, and plan-level proposals.
Who We Serve
Purpose-Built for Every Corner of Self-Insurance
ResultMD is engineered to work across multiple plan structures, giving your clients a competitive edge regardless of how their benefits are funded.
Drive Down PEPM & Total Plan Cost
Self-funded employers pay claims dollar-for-dollar. When ResultMD converts an administrative cost containment service into a medical claim, it flows through the plan's existing claim adjudication process, eligible for stop-loss reimbursement, benchmarking against industry norms, and improved reporting.
Learn More- Eligible for specific and aggregate stop-loss reimbursement
- Improves claims data transparency and benchmarking
- Reduces PEPM admin fees in proposal comparisons
- Supports more competitive broker RFP responses
For Distribution Partners
The Competitive Weapon Brokers and TPAs Have Been Waiting For
For Brokers & Consultants
Stop Losing Accounts to Admin Fee Optics
ResultMD lets you present proposals where eligible preventive and wellness engagement services appear as medical claims, not overhead. ResultMD claims are structured around preventive and wellness engagement services, a clinically defensible category that resonates with stop-loss underwriters and gives your proposals a credibility advantage beyond cost optics alone. The result is a cleaner, more competitive cost breakdown that wins more business and retains existing clients at renewal.
- Lower apparent admin cost in proposals
- Stronger renewal narratives backed by claims data
- Easy integration into existing benefit stack
- Commission-eligible partnership arrangements available
For Third-Party Administrators
Zero Workflow Disruption, Maximum Compliance
ResultMD integrates seamlessly with your existing adjudication workflows. Claims arrive pre-coded with NPI, HCPC-S, and ICD-10 data, ready for standard adjudication. No special platforms, no complex integrations. Claims arrive pre-coded and physician-documented, with full clinical rationale and audit-ready documentation available upon request, so your team never has to defend a claim it didn't build.
- EDI-compatible claim submissions
- Pre-coded with all required medical identifiers
- Fits inside existing TPA adjudication engines
- White-label partnership options available
Clinical & Regulatory Compliance
Built on a Foundation of Medical Legitimacy
ResultMD is not a billing workaround. Every claim produced through our model is backed by a licensed physician, properly coded, and fully documented.
Licensed Physician Oversight
Every service flows under the NPI of our board-licensed medical doctor, establishing genuine clinical authority over each claim event.
Proper HCPC-S Assignment
Certified medical coders assign the correct Level I or Level II HCPC-S procedure codes, ensuring payer and stop-loss acceptability.
ICD-10 Diagnostic Matching
Each claim includes a clinically appropriate ICD-10 diagnostic code, completing the medical necessity documentation required for adjudication.
ERISA & State Law Alignment
Our model is structured to comply with applicable ERISA provisions and state insurance regulations governing self-funded and level-funded arrangements.
Stop-Loss Carrier Defensibility
Claims produced by ResultMD are structured to withstand stop-loss carrier audit, with complete clinical documentation available upon request.
HIPAA-Compliant Data Handling
All patient and claim data is handled in full compliance with HIPAA Privacy and Security Rules, protecting plan sponsors and members alike.
Preventive & Wellness Category Eligibility
The services ResultMD structures as medical claims fall within preventive care and member wellness engagement categories that carry established clinical coding frameworks. Specific service eligibility, coding detail, and supporting clinical rationale are provided to credentialed TPA and stop-loss partners under executed partnership agreements.
The ResultMD Difference
Measurable Impact for Plans, Partners, and Members
5–26%
Reduction in effective plan cost
By shifting containment services to the medical claim layer, plans realize material cost reductions without cutting benefits.
100%
Claim compliance rate
Every claim exits our process with full NPI, HCPC-S, and ICD-10 documentation, zero clean claim deficiency.
Multi-Market
Plan type coverage
Self-funded, level-funded, PEO, and captive, one solution, every market.
Day 1
Integration readiness
Broker and TPA partners can begin presenting ResultMD proposals immediately upon onboarding.
Simple by Design
How Administrative Costs Become Medical Claims
ResultMD works exclusively with services that fall within recognized preventive care and member wellness engagement categories. Each service type is reviewed by our licensed physician for clinical eligibility before any claim is structured. This ensures every claim reflects a genuine, documentable patient interaction, not a reclassification of overhead.
Service Eligibility Review
The employer benefit plan is reviewed to identify services within recognized preventive care and member wellness engagement categories that qualify for medical claim treatment under applicable clinical standards.
Physician Review & NPI Assignment
ResultMD's licensed physician reviews the service event for clinical eligibility and certifies it under their National Provider Identifier, establishing medical authority over the claim.
Claim Coding & Documentation
Certified medical coders assign the appropriate HCPC-S procedure code and ICD-10 diagnostic code consistent with the service type. Full documentation is retained and available for stop-loss audit upon request.
Submission & Adjudication
The completed, pre-coded claim is submitted via standard EDI channels and adjudicated as a compliant medical claim within your existing TPA workflow.
Get Started with ResultMD
Ready to Offer More Competitive Plans?
Whether you're a broker, TPA, PEO, or captive manager, ResultMD gives you a clinically compliant, claim-based cost containment solution that changes the conversation at every renewal table.