Xifin, whose services include a large lab billing consultancy, offers an elaborate analytics system for payor contracting and pricing data. Find it at:
https://www.xifin.com/resources/payor-rate-transparency-monitor/
The online web page provides a sampler; for data contracts and strategic services contact Xifin.
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For example, in the screen shot below, set to code 80048 (metabolic panel), United has 590 distinct rates, Aetna has 578. United's weighted average is $8.39, Aetna's is $8.57.
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The bubble charts show volume per price (Dollar-cent), for example, Aetna has concentrations at $58, $56, $61 and $65.
(Somewhat similar data was seen in 2017 CMS PAMA pricing data, including popular price bands and including very high and very low outliers).
Hospitals & HHS
Federal laws require a level of hospital price transparency (at HHS here) but this doesn't display payor & independent lab adjudication.
- See hospital price transparency news at Bloomberg, Health Affairs, HealthExec, an open access strategy article by Mittler et al. here, and Stat. (AI summary here).
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See an article at Politico on whether AI can reduce payor administrative burdens.
https://www.politico.com/news/2023/12/31/ai-medical-expenses-00132557
