Caliber is independent pre-payment claims verification for self-funded employers. This is the whole model in five steps: where the gap is, what we check, what you receive, and what it's worth. Follow one claim from billed to verified.
Prior authorization decides whether a service starts. Adjudication pays the claim. But between the service and the payment, no one independently checks whether the bill is accurate. Billing error passes straight through that gap, unverified.
Once a claim is paid, getting money back means a year or more of disputes and fees — and you recover about 12 cents on the dollar [1]. Verify the same claim before payment and you keep 100 cents, because you never paid the bad claim in the first place. Everything after payment is collection. Collection recovers pennies.
That gap — 12¢ recovered versus 100¢ kept — is the entire reason the checkpoint moves upstream.
Caliber starts in behavioral health and SUD — the category with the highest billing variance and the lowest scrutiny. BH claims go out-of-network roughly 25% of the time, versus 5–10% for medical and surgical [2], which strips the audit leverage that post-payment recovery relies on. So the bill needs verifying before it's paid. Seven checks, on every claim:
Active license, correct scope of practice for the billed service.
IOP billed at residential rates, PHP duration beyond criteria, and similar mismatches.
Upcoding, unbundling, and modifier misuse on the billed codes.
Sessions running past clinical guidelines by more than 30%.
Missing or thin continued-stay justification in the record.
Out-of-network billed at in-network rates; unsupported rate overrides.
Same-day duplicate billings across provider entities.
And one fact underwrites every check: Caliber is paid only by the employer whose money is at stake — never by the TPA, the network, or the provider. No broker or consultant referral fee, paid or taken. A verifier that pays to be introduced is biased toward the party that introduced it — and that is exactly the bias we exist to remove. Independence is the moat.
When a check trips, Caliber documents the deviation and recommends the corrected amount on a Billing Governance Certificate. It is advisory: the dispositions are Verified, Adjust, Hold, or Escalate — never Deny. Caliber does not deny care and does not adjudicate. The employer and TPA decide. Here is a specimen finding.
Every flagged claim is documented, every recommendation quantified, and the whole trail is exportable and board-ready.
Caliber is $2 to $5 PEPM, tiered, plus 15 to 20% of verified prevented-overpayment — you keep the rest. The share is contingent: no savings, no fee. It works alongside your existing TPA and PBM, claims-level rather than network-level, with no workflow change and no provider disruption.
Caliber's founder built ClearBill, which returned $9.2 million to payers in its first six months of full deployment [3]. That system was post-payment. Caliber is what happens when you move the same checkpoint upstream — where you keep the whole dollar instead of recovering a fraction of it.