Industry Solution

Price Transparency for Payers

Reshape market dynamics | Build consumer-first strategy | Gain strategic advantage 

 

Industry Solution

Price Transparency for Payers

Reshape market dynamics | Build consumer-first strategy | Gain strategic advantage 

 

What’s in it for payers?

According to the CMS Transparency in Coverage Rule, from July 2022, Payers are required to publicly disclose negotiated rates of all services provided by their in-network providers and out of network allowed amounts in Machine-Readable Files (MRFs).

CitiusTech’s Price Transparency Solution ingests and curates publicly available Machine Readable Files (MRFs) to enable the following outcomes for Payers:​​

BI-Clinical

Reshape market dynamics by harnessing the true potential of
price transparency

SCORE+-1

Build consumer-first strategy
with redesigned & customized
product lines

MRR (1)

Gain strategic advantage with competitive pricing reducing
overall cost of care

BI-Clinical

Reshape market dynamics by harnessing the true potential of
price transparency

SCORE+-1

Build consumer-first strategy
with redesigned & customized
product lines

MRR (1)

Gain strategic advantage with competitive pricing reducing
overall cost of care

Starting with MRF data, health plans and health systems stand at a junction to innovate and monetize using the power of healthcare datasets for multiple operations
image (1)

Price Transparency & its Challenges

Most Payers intend to capitalize on publicly exposed information to get a competitive edge in the market but, here are several concerns to be aware of

Slide1

Enormous volume of data is now available in the market, but is not easily interpretable or consumer-friendly on its own without a super-computer

Slide2

Data accessibility is a challenge because payers have followed different approaches to publish their machine-readable files 

Slide3

Data inconsistencies from CMS mandated formats, mismatches and outdated numbers are at large making it difficult to analyze and extract a larger picture

Slide4

MRF data in silo is insufficient unless combined with provider demographics, taxonomy related information to derive meaningful insights

Slide1

Enormous volume of data is now available in the market, but is not easily interpretable or consumer-friendly on its own without a super-computer

Slide2

Data accessibility is a challenge because payers have followed different approaches to publish their machine-readable files 

Slide3

Data inconsistencies from CMS mandated formats, mismatches and outdated numbers are at large making it difficult to analyze and extract a larger picture

Slide4

MRF data in silo is insufficient unless combined with provider demographics, taxonomy related information to derive meaningful insights

Price transparency in Coverage provides enormous data publicly in the form of machine readable files and it takes a lot to activate this data and derive actionable insights.
Find out how CitiusTech's Price Transparency Offerings can empower health plans with a strategic advantage through transformative analytics and actionable insights.

PTA Infographic

 

CitiusTech Price Transparency Solution

Accelerate compliance and strategic organizational objectives

Regulatory Compliance​

MRF Engine to generate MRFs of In-network negotiated rates as per CMS rule

Curated Data as a Service ​

Scalable Data Platform to ingest & store publicly exposed healthcare data & share prepared data for analytics 

Insights for Payer Operations​

Analytics apps for payer use cases e.g., network operations, VBC strategy, claim pricing, actuarial

Enabled Smart Network Navigation ​

Direct to consumer delivery of price transparency-based analytics via digital front door

Regulatory Compliance​

MRF Engine to generate MRFs of In-network negotiated rates as per CMS rule

Curated Data as a Service ​

Scalable Data Platform to ingest & store publicly exposed healthcare data & share prepared data for analytics 

Insights for Payer Operations​

Analytics apps for payer use cases e.g., network operations, VBC strategy, claim pricing, actuarial

Enabled Smart Network Navigation ​

Direct to consumer delivery of price transparency-based analytics via digital front door

Advantages of Price Transparency Solution for Payers​

One-stop answer to all price transparency related questions!

H-Scale - hover

Scalable data platform to ingest & store large volume of pricing information from National, Blues and other payers

writing

Monthly curated data from multiple payers in readily consumable format for analytics use cases across payer value chain

HIT- Accelorators - hover

Comprehensive data quality checks
and standardization to address data 
inconsistencies, along with clinical
equivalence to analyze & extract a
larger picture

FAST+ - hover

Flexible architecture to include additional payer domain datasets (claims, quality, membership etc.) for future use cases beyond MRF

NEW-Perform+_Hover

Pre-built dashboards for specific payer workflows (network management) that can be further customized per client requirements

BIC-Audit_360-1

Reduced operational cost for payers to host and manage humungous datasets 

H-Scale - hover

Scalable data platform to ingest & store large volume of pricing information from National, Blues and other payers

writing

Monthly curated data from multiple payers in readily consumable format for analytics use cases across payer value chain

HIT- Accelorators - hover

Comprehensive data quality checks
and standardization to address data 
inconsistencies, along with clinical
equivalence to analyze & extract a
larger picture

FAST+ - hover

Flexible architecture to include additional payer domain datasets (claims, quality, membership etc.) for future use cases beyond MRF

NEW-Perform+_Hover

Pre-built dashboards for specific payer workflows (network management) that can be further customized per client requirements

BIC-Audit_360-1

Reduced operational cost for payers to host and manage humungous datasets 

Request a demo

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

front desk img


* As per regulation § 170.523(k)(1)(iii) of the ONC 2015 Edition Final Rule, the Cost and Limitations and Product Information Statement for BI-Clinical can be found here:  BI-Clinical 18.4, BI-Clinical 18.11, BI-Clinical 2020.1904 , BI-Clinical_BIC2021

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)