Healthcare payor price transparency is a federal requirement for payors and providers to make public their negotiated rates and charges. Stakeholders in this data can benefit greatly by analyzing rates associated with codes across payors and providers. Our solution, inFormed by Data - Payor Price Transparency pulls, processes, and publishes all the data monthly from each payor. We have engineered the analytics for the finance leadership at health systems for strategy, contracting, and revenue management.
Target Audience: Healthcare Provider CFOs, Finance VP/Directors, Revenue Cycle VP/Directors, Commercial and Managed Care Contracting offices, and Reimbursement VP/Directors.
Health system senior finance, strategy, and revenue cycle now have access to the actual negotiated rates for all the payors. Inside you will find your negotiated rates and easily compare them by payor. Next, you will be able to see and compare what other providers have contracted with for the same inpatient and outpatient codes. Finally, will be able to integrate this data with your historical, current, and forecasted utilization and payor mix. Custom view will enable you to manage your contracts better and be in a position of strength in negotiations.
Challenge
Health systems have struggled to compete effectively in the marketplace with aggregated data on negotiated rates by payor and code. As a result of the Executive Order in June 2019 regarding Hospital Price and Quality Transparency, each health system and payor is required to publish their negotiated rates in a machine-readable format at the contract level. Our solution pulls, processes, and publishes this data, specifically for the benefit of the health system. We have organized and enriched the raw data to make it easy to use and valuable.
Solution
The value is seeing the detailed data and enrichment information. Literally every in-network rate and allowed amount by NPI by Code by month is reported. We enrich the NPIs so we see entity names, Codes so we can group them by specialty, Periods so we can analyze over time, and much more.
Your health system can subscribe to our service on-line. You will access your data through your browser. Our basic service analyzes one organization based on their EINand all associated NPIs, one payor and their monthly updates, and all the medicare rates. Our professional services enable you to select 7 additional TIN to benchmark against and 5 payors of your choosing. Our enterprise service gives you access to all the TINs and Payors along with integration and 160 customization hours to fit your strategy.
