Define the comparison
Select the billing codes, payers, and locations used in the reimbursement model. Review the distribution for that set of records.
Reimbursement diligence
Compare payer-published rates for provider organizations by billing code, payer, and market. Use the comparisons to identify reimbursement assumptions that need further review.
Review reimbursement assumptions
Review provider rates
Compare the rates linked to the target's providers with those of relevant organizations in the same market.
Reconcile the assumptions
Export the comparison and record differences from the model. Review those questions against claims, contracts, and management records.
Scope of the data
Published negotiated rates provide market context. Claims and contract review remain separate parts of diligence.
Available comparisons
- Published rates for selected billing codes and locations
- Rate comparisons across provider organizations and payers
- Payer, plan, and provider context available in the source data
- Filtered exports for further analysis
Verify separately
- What was paid on a claim
- Realized revenue or collection rates
- Contract terms, bonuses, or value-based arrangements
- Whether every published rate is comparable
Questions about reimbursement diligence
Can published rates verify an organization's revenue?
No. Payer-published rates do not show what was billed, paid, or collected. Verify revenue and reimbursement assumptions against claims, contracts, and financial records.
How current is the data?
The payer coverage pages list available publication months. Include the snapshot month when comparing or citing results.
How do I access the rate explorer?
Choose a subscription plan with the filters and export options you need. You can review the product with sample data in the demo.
What data powers the comparisons?
OmniRate organizes in-network negotiated rates from payer-published Transparency in Coverage files, linked to available provider identifiers and organizations.