Your launch plan assumes a reimbursement rate. Can you show where it came from?
Medlyze provides what commercial payers and hospitals have published for the codes your product bills under, by payer and state, each with its source, with Medicare and Medicaid for reference.
Send your codes and the payers you are targeting. You get the latest commercial and hospital rates on record for each, by payer and state, within 24 hours.
Use it to evaluate reimbursement risk before launch, prioritize market opportunities, assess payer exposure, or support pricing assumptions.
What changes when the decision is made on the rate of record.
25 states pay between $284 and $1,073 for a purchased CPAP device.
A single national number hides that spread. Switch the code to see another. Medicaid fee schedules, real published rates; commercial payer and hospital rates for your codes come in the same record.
A rate brief for your codes
The latest commercial payer and hospital rates on record by payer and state, with Medicare and Medicaid, each with its source and effective date.
A coverage statement
Which payers and states are in, and what a source does not publish.
A reference your whole team can check
Pricing, market access and finance work from the same numbers.
These files are public.
They are. The work is collecting payer and hospital files, matching them to your codes and checking them, so you get an answer instead of a pile of files.
Do you cover my payers and codes?
Coverage for your payers and codes is stated before you commit. What a source does not publish is named.
We already have consultants.
Bring them. They can work from the same record: every rate has its source, so what they cite and what you cite match.
We already have benchmarks.
A benchmark compares. The rate of record shows the rate and where it came from. Send three codes and the benchmark you use, and we reconcile them.
Is the example real data?
Yes: the rates shown are real published Medicaid DME rates. Commercial payer and hospital rates for your codes come in the same record, each with its source.
Commercial payer and hospital rates, with Medicare and Medicaid fee-for-service rates. Not Medicare Advantage or managed Medicaid plan rates. Coverage and gaps →