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Reference-Based Pricing Solutions

Fair, transparent, and defensible pricing that can bring savings and affordability into focus.

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Fair Reimbursement

Data-Driven

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Aim to reduce costs, enable engagement, and address pricing gaps with data-driven RBP solutions.

In an environment in which healthcare prices are often opaque, having a partner that can bring clarity to costs can make all the difference — especially when it comes to making healthcare affordable.
 
Our reference-based pricing (RBP) services offer flexible, cost-effective, data-driven solutions aimed at reducing healthcare costs.

Reference-based pricing solutions and services designed to reduce balance billing, manage costs, and empower members.

Data iSight®

Data iSight®

Our alternative to U&C or Medicare-based reimbursement recommendations for out-of-network (OON) charges that delivers consistent, transparent results with high provider acceptance.

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Medicare

Medicare-Based Pricing

Claritev’s Medicare-Based Pricing service combines Medicare benchmarks with publicly available claim data to deliver fair, transparent, and defensible reimbursement — filling Medicare pricing gaps with confidence and consistency.

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Vistara™

Vistara™

A single solution that either exclusively offers reference-based pricing for facility and professional claims or integrates the PHCS Network and reference-based pricing to deliver transparency, insight, and access aimed at reducing the cost of care for employers and their members.

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Pro Pricer®

Pro Pricer®

Claritev’s data-driven, configurable solution that brings clarity to out-of-network cost management programs to enable savings.

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  • The things we value most about our partnership with Claritev are not just the reliable, efficient delivery of savings through their MSP and ESRD services, but the fact that they are always willing to come to the table to discuss and collaborate on new and innovative solutions that nobody else in the industry has yet to try.

    Drew Satriano, VP of Payment Integrity

    Highmark, Inc.

Engaging insights.

New ideas, proven best practices, and fresh perspectives for the healthcare ecosystem.

  • Illustration representing healthcare affordability and decision-making, featuring a profile with a gear icon, medical document, stethoscope, and cost symbols to highlight healthcare network strategy and price transparency.

    The Connection Between Better Decision-Making and Healthcare Affordability

    Healthcare affordability and access are often viewed as competing priorities—but they don’t have to be. By leveraging data-driven insights, network strategy, and greater price…

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  • Illustration of a hiker with a backpack walking toward a mountain peak with a flag at the summit, symbolizing achievement, leadership, progress, and reaching strategic goals.

    Why Pre-payment Integrity Matters More Than Ever

    Claritev’s recognition as a Leader in Everest Group’s 2026 Pre-payment Integrity Solutions PEAK Matrix® Assessment highlights its decades of expertise helping health plans improve…

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  • Executive brief on healthcare price transparency strategies, highlighting five considerations for turning transparency data into value through network optimization, rate normalization, and affordability insights.

    Five Considerations for Turning Transparency into Value

    Learn five essential strategies for operationalizing healthcare price transparency data, from rate normalization and site-of-care insights to network optimization and affordability-focused decision-making.

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How can Claritev’s data-driven approach to reference-based pricing make a difference for you?

Reach out to learn how our solutions can go beyond reducing costs and increasing transparency by enabling affordable care for all.

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