XiFin introduces new payor rate transparency monitor to inform diagnostic provider reimbursement strategies

Dec. 19, 2023
Online tool maps aggregate billing code reimbursement data from three top payors to improve provider financial health and support patient testing needs.

XiFin, Inc. announced that it has launched the Payor Rate Transparency Monitor, the interactive visualization tool that compares contracted rates published by UnitedHealthcare, Aetna, and Cigna.

The Monitor takes a further step in advancing transparency of contracted rates across health plans by drilling down into specific billing codes and modifiers that have been developed by the Centers for Medicare & Medicaid Services (CMS). These data help laboratories and diagnostic providers in defining and refining their managed care, market access, and contracting strategies, by showing the range of contracted rates for the most common services, as well as actual reimbursement rates. Providers are then able to compare this to their cost data to make informed decisions and negotiate rates with renewed confidence.

The data analyzed by XiFin’s Payor Rate Transparency Monitor is a result of the Health Plan Transparency in Coverage Rule. The Rule requires payors to provide data files of billing codes for all agreed-upon in-network and out-of-network reimbursement rates to CMS. Though publicly available, these petabytes of health plan data are difficult to work with and complex to summarize. For the Monitor, XiFin data scientists have meticulously processed, analyzed, and converted such data into consumable insights, including cross-payor visualizations.

Leveraging rich data and robust visualization, the Monitor allows users to examine the following:

  • Explore In-Network Contract Rates: Compare UnitedHealthcare, Aetna, and Cigna across common billing codes and related billing modifiers.
  • Spotlight Detailed Visualizations: Dive into interactive bubble charts and comprehensive analyses that showcase the lowest, highest, and weighted average rates for each payor for specific services.
  • Feature New Codes Monthly: While the Monitor starts with 23 common codes, such as lipid panel and urinalysis, each month XiFin will highlight a new set of codes.

XiFin release