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price transparency health plan payer MRF

We provide health plan negotiated rates between payers and care delivery organizations, sourced from payers and transformed for business insights.

price transparency health plan payer MRF
snowflake marketplace price transparency
snowflake marketplace price transparency

Snowflake Marketplace Users

Price Transparency Solutions

Protect your revenue, improve reimbursement, power your solutions, and make your services smarter with detailed and accurate contracted rates.

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Delivering price transparency data to your ecosystem, curated for your needs.

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Self service exploration of contracted rates across all payers, health plans, and care delivery organizations.

Practical Applications

Trillions of rows of data mean nothing if they aren't curated to remove the noise from phantom rates, duplication, and irrelevant billing codes. We have done the work for you, allowing you to focus on optimizing your bottom line.

Rate disparity across major payers for Psychiatric Diagnostic Evaluations

Between the highest and lowest rates for a 45-min therapy session

Between the highest and lowest rates for Level 3 Est. Patient Office Visits

Customer Testimonial Price Transparency

“Our payer negotiations were approaching and we were in the dark, but with Payerset we were able to see the range of negotiated rates at our payers for Behavioral Health organizations like us. Payerset empowered us to develop the right strategy and gave us the confidence to get competitive rates for our high utilization services.”

Holistic women’s mental health therapy, counseling, and medication management.

- Shama Rathi, MD, Co-Founder

hellolunajoy.com

Empowering Industry

It’s our mission to lower the cost of healthcare in the U.S. through transparent and democratized pricing. Help create change with price transparency.

price transparency health plan payer MRF

Healthcare Providers

Protect your negotiated rates and leverage this data to strategically improve reimbursement.

Strategic Consulting

Help your customers with benchmarking, compliance, and strategic consulting services.

Technology Solutions

Integrate Payerset data into your existing software solutions to enhance their recommendations.

Get Started
2 NPIs, 2 billing codes, 2 payers

Request 2 NPIs, 2 billing codes, and 2 payers that you are interested in and we will share the data with you for validation or check out our free sample data in the Snowflake Marketplace.

Let’s talk about how price transparency data can empower your organization.

WE WILL BE IN TOUCH SHORTLY!

  • What is "Payer Price Transparency" Data?
    "Payer Price Transparency" data refers to the information that health insurance companies (payers) are required to disclose about the prices they have negotiated with healthcare providers for various medical services. This data includes detailed records of the rates for medical procedures, services, and items, as negotiated between payers and providers. It is mandated by regulations such as the Hospital Price Transparency Rule and the Transparency in Coverage Rule. The purpose of this transparency is to empower patients, employers, and other stakeholders to compare prices across different providers and payers, facilitating more informed decision-making and fostering competition in healthcare. Payerset leverages this data to offer comprehensive datasets and self-service data exploration, enabling organizations to use the information for cost management, competitive pricing, and strategic planning​​​​​​. See the CMS "Transparency in Coverage Overview" here: https://www.cms.gov/files/document/transparency-coverage-webinar-naic-06-27-22-508.pdf
  • What’s the Difference Between Hospital and Health Plan (Payer) Price Transparency Data?
    While both datasets aim to promote transparency in healthcare costs, hospital price transparency focuses on the charges for services directly from hospitals, and health plan (payer) price transparency focuses on the rates negotiated between insurers and all care delivery organizations (including hospitals) and individuals.​​
  • What Does the Payerset Price Transparency Data Include and How Detailed Is It?
    Payerset retains all detail posted by the insurance companies within their machine readable files (MRFs) and further enriches and cleanses that data for analytics and insights. Here is an overview of what Payerset data includes and its level of detail: Negotiated Rates: Content: The data includes negotiated rates for medical procedures, services, and items between payers (insurance companies) and healthcare providers. These rates are the actual amounts that insurers agree to pay providers. Detail: The rates are broken down by service, provider, and location, allowing for granular analysis of healthcare costs across different regions and providers. Billing Codes and Descriptions: Content: Detailed billing codes (such as CPT, HCPCS) and descriptions for various medical services and procedures. Detail: Includes comprehensive coding information which is essential for understanding specific healthcare services and their associated costs. Plans and Providers: Content: We provide all commercial plans and networks for a full picture of the payer's reimbursement rates by NPI (National Provider Identifier) Detail: Covers all providers and plans, offering a complete view of the U.S. healthcare market. For more details, please see our Data Dictionary here: https://docs.payerset.com/rate-explorer/data-dictionary
  • How Often Is the Data Refreshed?
    Payerset refreshes its data quarterly. This means that every three months, Payerset updates and audits its entire data set to incorporate the latest changes in payer data structures, negotiated rates, and any new regulatory requirements. These regular updates ensure that users have access to the most current and accurate information available. In addition, Payerset always keeps the historical payer data. Please see our latest payer compliance audit results here: https://docs.payerset.com/payers/aetna-price-transparency
  • How Does Data Synchronization Work?
    We will work with you and your technology organization. Every organization is different depending on your environment, platforms, and processes. We support all major clouds and can provide the data in various formats. Snowflake customers can easily access and purchase our data via the Snowflake Marketplace.
  • Does Payerset Handle Schema Drift as Upstream Data Structures Change?
    Yes. There can be regular schema changes based on payer updates in price transparency compliance. There can also be changes based on updated CMS rules. We normalize the data before you receive it, so we handle these changes for you. We will never remove fields, as that would affect your downstream processes, but we may add fields based on new requirements.
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