Payer Contract Analytics
Most provider organizations walk into payer negotiations with anecdotes; payers walk in with actuaries. Quant Solvent levels that table: reimbursement rates benchmarked against Medicare and market data, underpayments detected in your remittance history, and proposals modeled in dollars before you sit down.
How do you know if a payer is underpaying you?
Two analyses answer it. Benchmarking expresses every negotiated rate as a percentage of the Medicare allowable for the same code and locality — the common denominator of rate negotiations — and compares it against market reference points, including public price-transparency data. Underpayment detection compares what each payer actually allowed on your claims against what your contract says they should have allowed, at scale. One tells you where the contract is weak; the other tells you where the contract isn't even being honored.
"Percent of Medicare" is the standard yardstick for commercial reimbursement: a contracted rate of $130 for a service Medicare allows at $100 is "130% of Medicare." Expressing your whole fee schedule this way makes weak codes and weak payers immediately visible.
What goes into the negotiation package?
- Rate benchmark report — your rates vs. Medicare and market reference data, by code family and payer
- Underpayment analysis — contract-vs-actual variance from your 835 history, with recoverable dollars quantified
- Volume-weighted impact model — which codes actually matter, so negotiation effort goes where the dollars are
- Proposal scenarios — each counter modeled in annual dollar impact before you respond to it
- Negotiation support — preparation and data backup for your team through the process
Why this is a data engineering problem
The inputs are messy by design: fee schedules in PDFs, allowed amounts buried in remittance files, price-transparency disclosures published as enormous machine-readable files. Getting them into one analyzable structure is precisely the kind of pipeline work we do every day — which is why a data engineering firm produces a sharper negotiation package than a spreadsheet ever will.
Frequently asked questions
What data do you need to analyze our payer contracts?
Three inputs do most of the work: your payer fee schedules (or loaded contract terms), your remittance history (835s) showing actual allowed amounts, and claim volume by code. Public price-transparency files and Medicare fee schedules supply the market benchmarks.
What is underpayment detection?
Comparing what a payer actually allowed on each claim line against what your contract says they should have allowed, at scale. Systematic variances are recoverable revenue and strong leverage in the next negotiation.
Do you negotiate with payers on our behalf?
Our core deliverable is the analysis negotiations run on: benchmarks, underpayment evidence, and modeled proposals. We support your team through the negotiation itself — preparation, counter-scenario modeling, and data backup — scoped per engagement.
Walk into your next negotiation with the numbers
Tell us which contracts renew next. You'll get a scoped analysis plan and a same-day Statement of Work.
Book a 30-minute intro call Prefer email? clayton@quantsolvent.co