When you benchmark your contracted rates, ask: does this benchmark come from an independent source?
Every major healthcare analytics vendor you've looked at either serves the payors whose rates we are benchmarking, or doesn't do the billing audit work. We do both, from an independent position.
Your benchmark provider may have a conflict of interest.
Traditional benchmark providers serve both sides of the transaction. They sell analytics to employers while earning revenue from the carriers whose contracts you're trying to evaluate. The benchmark is structurally compromised.
If your analytics provider also serves the payors whose rates you're benchmarking, the benchmark itself is conflicted.
We built Price Intelligence on CMS-mandated MRF data specifically to eliminate this conflict. No payor relationships. No carrier revenue. Just market data.
Built for the teams that fight for fair pricing.
Whether you negotiate contracts, defend fiduciary duty, or advise on plan design — we give you independent market data to back every decision.
RBP Employers
Balance billing defense evidence. Market percentile proof for every disputed claim.
- MRF-based reasonable rate evidence
- Market percentile positioning
- Member balance billing protection
Self-Insured Employers
ERISA compliance + contract benchmarking + claims-level audit in one platform.
- Quarterly fiduciary compliance reports
- TPA contract rate benchmarking
- Every claim audited, not a sample
ERISA Attorneys
Fiduciary audit documentation with defensible methodology for litigation.
- Section 404(a) compliance evidence
- Expert-defensible rate benchmarks
- Litigation-ready documentation
Also serving brokers, benefits consultants, and advocacy platforms.
Five capabilities. One independent platform.
From contract benchmarking to ERISA compliance — everything built on CMS-mandated MRF data with full methodology transparency.
Contract Benchmarking
Compare TPA contracted rates against the entire market. See where you pay above median — and by how much.
- Per-CPT rate vs. market percentile
- Facility-level comparison across metros
- Annual overpayment quantification
TPA Repricing Audit
Audits the contract, not just the claims. Verifies your TPA's reported savings against independent market data.
- Independent savings verification
- Contracted rate vs. market rate analysis
- TPA performance accountability
Claims-Level Billing Audit
10 error types. Every claim. Not a sample. AI-powered detection catches what manual review misses.
- Unbundling and upcoding detection
- Duplicate charge identification
- Plan term compliance verification
ERISA Fiduciary Reports
Quarterly compliance documentation that satisfies Section 404(a) duty-to-monitor requirements.
- Monitoring summary with benchmarks
- Findings and remediation tracking
- Defensible methodology appendix
Balance Billing Defense
MRF-based evidence packages with market percentiles. Defend reasonable rates with independent data.
- Market percentile positioning reports
- Provider-specific rate comparisons
- Member protection documentation
From data to insight in two weeks.
No integration. No IT project. Send claims data and a plan document — we deliver actionable intelligence.
Send Claims Data
Share your claims data and plan document. We handle the rest.
Rate Normalization
We normalize your rates against 6,000+ hospital MRF files.
AI-Powered Audit
Every claim audited against market benchmarks and plan terms.
Reports Delivered
Contract audit report + evidence packages ready for action.
See what the engine produces.
Real report formats built on normalized MRF data. Every number defensible. Every methodology transparent.
| CPT | Description | Your Rate | Market Median | Percentile | Annual Overpayment |
|---|---|---|---|---|---|
| 27447 | Total Knee Replacement | $10,722 | $7,942 | 95th | $22,240 |
| 72148 | Lumbar MRI w/o Contrast | $8,847 | $6,553 | 95th | $64,232 |
| 43239 | Upper GI Endoscopy w/ Biopsy | $409 | $303 | 53th | $1,378 |
| 99213 | Office Visit, Est. Patient | $167 | $124 | 95th | $17,200 |
| 96413 | Chemo Infusion, First Hour | $781 | $781 | 50th | $0 |
| 70553 | Brain MRI w/ & w/o Contrast | $645 | $478 | 62th | $5,010 |
Full transparency. By design.
We publish our methodology because we have nothing to hide. Every benchmark is built on CMS-mandated data with documented normalization steps, confidence scores, and freshness labels.
Unlike providers who treat their methodology as a trade secret, we believe transparency is the only way to build trust — especially when fiduciary compliance is on the line.
- CMS-mandated Machine-Readable File sourcing
- 6,000+ hospitals indexed nationwide
- 50 payers tracked
- 100,000+ rates analyzed
- Data freshness labels on every rate
- Confidence scores for every benchmark
- Full methodology document available on request
What are above-market rates costing you?
Most self-insured employers overpay 3-7% on contracted rates. See what that means for your plan.Based on our analysis, Houston-area commercial rates average 320% of Medicare across 147 procedures.
Common questions, straight answers.
Find out what your contract data is hiding.
Independent analysis. Full methodology transparency. No commitment. We'll show you exactly where your plan is overpaying — and by how much.
Or email: partners@priceintelligence.org