Methodology

From a public file to a rate record.

Five steps. Each one leaves something a buyer can check.

1

Collect

Public files are downloaded on a schedule: commercial payers’ negotiated-rate files and hospitals’ price transparency files first, then Medicare and Medicaid fee schedules. The file, its publication date and the retrieval date are kept.

Source · date
2

Normalize

Billing codes, modifiers, states and rate types go into one schema.

Field list
3

Check

Rates are compared with the source. Blanks, impossible dates and unit mismatches are flagged. The latest published rate from each source is the rate on record.

Known issues
4

Grade

Payer and hospital files get a file-quality score from 0 to 100 and a grade from A to F.

Components
5

Record

One rate, with its provenance, is stored and delivered.

The record
The record

What a record carries.

  • 1
    The rate.With its type and modifier, so rental, purchase and used are never mixed.
  • 2
    The source.The public file it came from: a hospital, a payer, Medicare or a state.
  • 3
    The effective date.When the source says the rate took effect. The record holds the latest published rate.
  • 4
    The check date.When Medlyze last confirmed it against the source. Hospital and payer records add a file-quality grade from A to F.
Rate recordCommercial payer · New York
Code
DRG 194 · Simple pneumonia and pleurisy with CC
Payer
United Healthcare
1Rate
$20,771.00
Type · modifier
Case rate, median of 113 providers · none
2Source
United Healthcare negotiated-rate file (Transparency in Coverage), 2026-08
3Effective
8/1/2026
4Checked
9/16/2026
Rate recordHospital · New York
Code
DRG 194 · Simple pneumonia and pleurisy with CC
Hospital
Montefiore Medical Center
1Rate
$6,554.17
Type · modifier
Case rate, median of 8 commercial payers · none
2Source
Montefiore Medical Center price transparency file (standard charges)
3Effective
4/1/2026
4Checked
9/16/2026

How the record is built.

1

Reimbursement Data

Hospital, payer, Medicare and Medicaid rates, collected and normalized in one record.

Delivered
2

Reimbursement Evidence

Each rate with its source, date and grade, compared with the market. (Was “Intelligence”; founder to choose.)

Delivered
3

Applications

Rate files, search, lookup, ratings and the contract benchmark.

Contract benchmark delivered by Medlyze
4

Workflows

Launch pricing, payer renewals, market-access plans, competitor benchmarks.

How teams use it
Normalize

One CPAP code. Twelve ways to be paid.

E0601 appears in 48 states under 12 modifier forms: rental, new, used, lease and others. Commercial and hospital files add their own variants: plan and product, billing class, place of service and the negotiation arrangement. A lookup that ignores them gives a number that may not be the one you bill.

E0601CPAP deviceRR rental41 statesnone no modifier23 statesNU new12 statesLL lease3 statesUE used3 statesKH1 stateKI1 stateKJ1 stateKR1 stateMS1 stateRA1 stateRB1 stateStates with at least one E0601 row under each modifier · 48 states · 12 forms
Quality scoring

What a grade means, and what it does not.

A grade describes how complete and usable a published file is. It is not a compliance finding and not a statement about the accuracy of the underlying prices.

Payer filesHospital files
ComponentsAccessibility · Parseability · Domain stability · FreshnessPublication · Completeness · Accuracy · Freshness
Output0–100, grade A–F0–100, grade A–F, percentile, trend
Versionmethodology v2methodology v2
Security and data handling

Customer files are used only for that customer’s request, under agreement. No security attestation is claimed.

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