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Machine Readable File Analytics for Payers

Transform CMS Coverage Transparency Regulation into Strategic Advantage

 

Benchmarking Market Competitive Edge

The Transparency in Coverage Act presents an unprecedented opportunity for health plans to benchmark against valuable market data and generate competitive insights.

Analytics on publicly available Machine Readable Files (MRFs) in-network, OON allowed amount, hospital standard charges can empower health plans with strategic decision support such as:

  • Contracted rate analysis against competitors and regional benchmarks
  • Adjustments needed to existing negotiated rates
  • Network design optimization opportunities
  • Service or provider-specific value based contract transition opportunities

Learn more about MRF Analytics for Payers

Fast forward, MRF data can also be combined with core operations data to inform key decisions across the payer value chain such as:
  • Actuarial decisions for optimized benefit design
  • Value based contract modelling and narrow network design
  • QPA analytics for out of network reimbursements
  • AEOB analytics for ‘No Surprises’ enablement
  • Agent / self insured group sales insights

How can we help ?

CitiusTech can deliver an end to end MRF Analytics solution with AI-augmented decisions across payer operational workflows complemented with MRF data architecture, data science & payer consulting.

MRFA Schematic

 

Machine Readable File Analytics for Payers: Advantages

CitiusTech MRF Analytics solution has been designed to enable Transparent exchange, Proactive coordination & Enhanced decisions that ultimately influences Payer Enterprise Outcomes.

FHIR-Blog-Series--Part-4-of-8-CMS-Interoperability-_-Patient-Access-Rule---FHIR-Bulk-Data-API@2x
Comprehensive assessment for MRF data readiness
Mirth-Version-Control-and-Multi-server-Monitoring
Subject matter expertise for defining MRF data architecture
HEDIS-Compliance-Are-You-in-Control@2x
Out of the box reports with library of key metrics & AI/ML models
What-We-Want-to-See-at-RSNA-2012---Wish-List
Rapid prototyping framework for model operationalization (MLOps)
FHIR-Blog-Series--Part-4-of-8-CMS-Interoperability-_-Patient-Access-Rule---FHIR-Bulk-Data-API@2x
Comprehensive assessment for MRF data readiness
Mirth-Version-Control-and-Multi-server-Monitoring
Subject matter expertise for defining MRF data architecture
HEDIS-Compliance-Are-You-in-Control@2x
Out of the box reports with library of key metrics & AI/ML models
What-We-Want-to-See-at-RSNA-2012---Wish-List
Rapid prototyping framework for model operationalization (MLOps)

Consult our professionals

Get to know more about the services we offer. We are glad to help you.

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