Which payers are worth pursuing? The answer should come from rates and covered lives, not relationships.
Medlyze provides what commercial payers have published for your test codes, by payer and state, and your payer market share from enrollment data.
Use it to evaluate coverage opportunity, benchmark reimbursement assumptions, choose the next payer, or support commercial planning.
Send your test codes and payers. You get rates by payer and state, and the payers where you have no contract, within 24 hours.
What changes when the decision is made on the rate of record.
Four New York payers publish four different medians for the same code.
Real published commercial rates, by payer and hospital. Switch the code to see another. Your test codes come in the same record, with Medicare for reference.
Dot = median · thin line = lowest to highest rate · shaded bar = middle half of a payer’s providers
Test-code rates
Commercial payer and hospital rates for CPT and PLA codes, by payer, with Medicare for reference. (Code coverage to be confirmed before launch.)
Market share
Your contracts resolved against national enrollment, by state and product.
The gap list
Payers ranked by covered lives where you have no contract.
Interesting, but is it relevant to a lab?
If you contract with payers for tests, rates and covered lives decide which contract is worth the effort. Send your test codes and see.
Do you cover my test codes?
Test-code coverage is stated before you commit.
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.
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.