Solution Focus: CitiusTech's 'Price Transparency for Provider Systems' helps providers understand where they stand with the negotiated rate in comparison to other providers in their market region. Providers can identify opportunities to negotiate better rates with their payers thereby increasing their revenue by way of reimbursements.

The monthly Payer Machine Readable Files (MRF) generated provide pricing data for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts.

The solution ingests and curates data from MRFs, Medicare Rates and National Physician Indicator (NPI) Metadata to help provide Health systems with:

Business Use cases:

a. Highly informed rate negotiations with payers

b. Identify and act upon pricing anomalies in the market

c. Setting accurate benchmarks with competitors

d. Insights for target provider network, for practice acquisitions

Value Delivered:

- Curated Data set of Providers by region, zip codes, service category

- Curated Provider Price Transparency database

- Price Transparency dashboard for Provider system

Solution components:

1. Enriched Data as a Service: Scalable data platform to ingest and store publicly available MRFs & prepare for analytics

2. Bring Your Own Data: Isolated cloud platform combining MRF data with enterprise datasets, Operational analytics

3. Benchmark Reports:

- Show comparison of rates between Provider and its competition in same market

- Show negotiated rates by Utilization of procedures

- Show negotiated rates by MIPS score

Solution advantages:

1. Scalable SaaS-based data platform to ingest & store large volume of pricing information from National, Blues and other payers

2. Monthly curated data from multiple payers in readily consumable format for analytics

3. Comprehensive data quality checks and standardization to address data inconsistencies, along with clinical equivalence to analyze & extract a larger picture

4. Flexible architecture to include additional provider domain datasets for future use cases beyond MRF

5. Pre-built dashboards for specific provider use cases

6. Reduced operational cost for providers to host and manage humungous datasets

Price Transparency for Provider Systems

Autor: CitiusTech