Information Guides
Expert insights on healthcare pricing and contracting
Practical, actionable guides to help you navigate healthcare price transparency, optimize payer contracts, and make data-driven decisions.
Medicaid Fee Schedule Lookup by State: Why It's Harder Than Medicare
A practical guide to Medicaid fee schedule lookup by state: why Medicaid has no single national rate schedule, what trips up RCM teams and DME suppliers, and how to get the rates you actually need.
Payment Integrity vs. Prospective Rate Benchmarking: What's the Difference?
Payment integrity audits claims after they're paid. Rate benchmarking prices a renewal before you sign it. Why brokers need both, and why they're not the same tool.
Why Medicare Advantage and Medicaid Enrollment Data Goes to the Plan Level (and Commercial Doesn't)
Medicare Advantage and Medicaid enrollment data resolve to the plan level. Commercial data never does. Why, and what it means for your market share analysis.
Medicare Advantage and Managed Medicaid Enrollment by Plan, Not Just Carrier: An Arizona Example
A real, verified example of plan-level Medicare Advantage and Managed Medicaid enrollment data, down to individual plan brands and parent companies in Arizona.
Payer Contract Intake Checklist for a Market Share Analysis
The exact fields a payer network coverage and market share analysis needs from your contract list, and why a partial export is still enough to start a pilot.
Blue Cross Blue Shield Price Transparency: It Depends Which BCBS You Mean
Blue Cross Blue Shield isn't one company - it's 34 independent licensees, each with its own price transparency compliance score. See real data on 12.
Reasonable Value of Medical Bills in Personal Injury Cases: The Public Data Alternative to Discovery
The reasonable value of medical bills in personal injury cases can now often be shown from public data - no discovery motion required for negotiated rates.
How to Set a Defensible Reference-Based Pricing Benchmark
Set a defensible reference-based pricing benchmark from real hospital price transparency data, not a flat Medicare percentage, and audit TPA savings claims.
Medical Bill Review for Workers' Comp: Process & Savings
How medical bill review works, step by step: workers' comp and PI rules, itemized bill review, billing errors to catch, and when to hire experts.
Payer Contract Negotiation: Benchmark Rates, Set Targets
A practical guide to payer contract negotiations: benchmark your rates against negotiated-rate data, set regional target rates, and prepare for the table.
Understanding Healthcare Price Transparency
Navigate the complex world of healthcare price transparency regulations, from CMS rules to accessing and interpreting transparency data files.
Benchmark Reports
Recurring, data-driven benchmarks tracked over time — starting with The State of Commercial Reimbursement →
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