Data & scope
What the analysis
can tell you.
Public payer files can support useful comparisons. Their limits matter when you use the findings in a contract negotiation, a financial model, or a research project.
Published rates and actual payments
Our rate benchmarks use public in-network negotiated rate records. They do not establish what was paid on a specific claim, how frequently a procedure was billed, or how a claim was adjudicated. Those questions require additional data.
Coverage and publication dates
Coverage is specific to the payer, geography, plan, and setting. Findings reflect the source files available for the analysis. We confirm the relevant coverage and publication dates when scoping a project.
Comparable rates
A provider identifier or procedure code alone does not make two rates comparable. Rate type, plan structure, setting, and peer selection need to be considered. We document those choices and the gaps that remain.
Advisory scope
We support financial analysis, development, and payer negotiations. Legal review of contract language and regulatory requirements belongs with your counsel and application team; actuarial risk pricing is a separate discipline.