Payer contracting and reimbursement analysis
Know what payers pay your competitors.
Commercial insurers publish the rates they have negotiated with in-network providers. We process those files and use them to help community hospitals, surgery centers, and provider groups negotiate payer contracts and plan new projects.
Services
Where we can help
Each engagement draws on the same payer rate data, applied to the decision in front of you.
Payer contract negotiation
Renewals and new agreements, prepared with the rates the same payer has published for comparable providers.
Rate benchmarking
A review of where your reimbursement sits against peers, by payer and procedure, before a renewal comes up.
DON / CON support
Market, utilization, and financial analysis for Determination of Need and Certificate of Need applications.
Development and feasibility
Feasibility models for surgery centers, service lines, and facility projects where reimbursement decides the outcome.
The data
The rate data behind the work
We built and run our own pipeline for payer price transparency files. Coverage includes UnitedHealthcare and Cigna nationally, Optum Behavioral Health, Blue Cross plans in Arizona, Florida, Massachusetts, and Michigan, and several regional Massachusetts payers.
A published rate shows what a payer agreed to pay. It doesn’t show what a given claim paid, and we keep that distinction in every finding.
Data coverage and limitsCurrent work
We are supporting a Massachusetts community hospital in commercial payer renegotiations across acute and behavioral health services.
Get in touch
Tell us about the contract or project.
Send a short note about the payer, the project, and your timeline. Andy will reply within 1–2 business days to set up a call.
Contact Andy