Transparency-Based Pricing
A fair, transparent solution providing consistent, widely accepted reimbursement recommendations for out-of-network claims.
Pricing Intelligence
Transparent Rational
Building a Reimbursement Strategy Around Transparency Data
More than 1.7 trillion machine-readable file (MRF) records are now available, creating new opportunities to inform reimbursement strategies. But MRF data is massive, fragmented, and difficult to use without the right expertise and methodology. For organizations managing out-of-network costs, the challenge is turning transparency data into actionable pricing intelligence.
Turning Transparency Data Into Pricing Intelligence
Claritev’s Transparency-Based Pricing solution combines AI-enabled MRF processing with more than 40 years of pricing and reimbursement expertise. The result is market-informed reimbursement recommendations for eligible out-of-network claims that are grounded in federally mandated data and provide an explainable reference point for pricing decisions.
How Transparency-Based Pricing Helps
See the market more clearly with intelligence grounded in federally mandated transparency data.
Identify reimbursement variation to inform medical cost management strategies.
Put complex MRF data to work without building internal transparency data pricing infrastructure.
Advance pricing innovation without building internal transparency data infrastructure.
Support explainable reimbursement decisions with repeatable pricing rationale.
Built to Turn Transparency Data
Into Pricing Intelligence
AI-Enabled Data Standardization
- Ingest, clean, normalize, and standardize MRF data at scale
- Transform fragmented transparency data into actionable pricing inputs
- Support benchmarking, pricing strategy, claims operations, and cost management
Market Reimbursement Intelligence
- Combine transparency data with reimbursement expertise
- Deliver market-informed reimbursement intelligence
- Increase visibility into reimbursement dynamics by provider, code, service category, and geography
Transparent, Explainable Methodology
- Apply repeatable pricing logic and configurable business rules
- Generate claim-level reimbursement recommendations
- Provide clear, explainable pricing rationale within existing workflows
Designed to Support OON Pricing Strategy
Support a broader reimbursement toolkit
Enable more consistent pricing decisions
Help reduce internal data complexity
Support explainable reimbursement rationale
Create visibility into pricing opportunities
Support medical cost management strategies
Engaging insights.
New ideas, proven best practices, and fresh perspectives for the healthcare ecosystem.
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Put Transparency Data to Work
Connect with Claritev to support your reimbursement strategy, claims operations, and medical cost management.