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Transparency In Coverage For Industry Optimization

Informing Internal Pricing & Contracting Strategies
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Comprehensive Competitive Pricing Insights

As of July 1, 2022, the Centers for Medicare & Medicaid Services (CMS) Transparency in Coverage law, health plans have been mandated to publish machine-readable files (MRFs) containing in-network negotiated rates and out-of-network pricing intended to inform consumers of the costs associated with a service or product before care is provided.

While MRFs are required to be publicly accessible, deciphering their many file types and architectures requires dozens of people working full time on ETL transformations, Python development instances, and managing large numbers of Apache Spark Clusters to transform and manage the Terabytes of data updated monthly.

Our Transparency in Analytics solution simplifies over 1,400 MRFs into valuable insights using automated metadata discovery and data mapping. Healthcare and insurance providers from Blue Health to Kaiser are using today for competitiveness benchmarking, Transparency in Analytics data for network analysis, and cost transparency.

Promethium's Transparency in Coverage solution provides your team with:

Access to reliable, competitive data, visualized side by side with your plan data aggregated, organized, and enriched.

Increased visibility by incorporating Promethium's national healthcare pricing data and your local plan's data.

Understanding your rates and services relative to competitors and market peers.

Complete understanding of your healthcare competitors' networks, pricing and contracting strategies.

Competitive pricing insights are easily accessible to your business and analytics teams
Maintain Your Competitive Advantage
Leverage your industry's public pricing data in a single, easy-to-use platform. Promethium enables your plan to unlock value in local markets and predict national trends. This level of integration accelerates your plan's analyses and internal pricing and contracting strategies saving you valuable time and analytics resources.
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Insights at a Glance

Promethium's reporting provides an easy-to-understand overview of how your pricing compares to other health plans in a given geographical area. Your plan's provider networking and contracting teams can drill down by county or region to view regional benchmarking data and compare services across specialities, noting where your service falls short or excels compared to alternatives. In addition, you can analyze the pricing for specific facilities and provider groups and by particular services to understand your competitive positioning before meeting with administrators.

See how Promethium can help optimize your healthcare pricing and discounting strategy.

Armed with this reimbursement benchmarking and cost transparency information, your plan can optimize its network strategy and strengthen its negotiating power using actual competitor information updated monthly.

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Want to Learn More?

Promethium's Transparency Analytics offering is flexible. Build customized data visualization for your local area or review nationwide competitive analytics.

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