Employer Rate Intelligence Methodology

Every report is computed from health plan price data that insurers publish under the federal Transparency in Coverage rule, combined with public regulatory filings. No proprietary surveys or estimates are used to produce the negotiated rates shown.

Data sources

Transparency in Coverage files: negotiated in-network rates by plan, provider, and billing code.
Department of Labor Form 5500 filings: employer identity, headquarters, participant counts, and industry.
NPPES and NUCC taxonomy: provider identity, location, and provider classification.
CMS Medicare fee schedules: provider-appropriate Medicare payment benchmarks.

Identifying employer plans

Payer plan lists are joined to Form 5500 filings through employer identification numbers. Plans are resolved to the reporting entity that best matches the employer's headquarters state, with national administrators used where no state-specific entity exists.

Billing-code and provider scope

Reports cover a fixed panel of 500 high-impact CPT, HCPCS, and MS-DRG codes selected from national commercial utilization. Each report includes organization providers in the employer's headquarters city. Code-to-taxonomy rules restrict comparisons to provider types that plausibly bill each service.

Rate eligibility

Before aggregation, rates must use an eligible billing-code type, a fee-for-service arrangement, an allowed place of service, and a standard-rate modifier. Provider NPIs must be structurally valid and present in NPPES.

Market and Medicare benchmarks

Each provider and billing-code combination is compared with a rate-count-weighted benchmark across the major payers Payerset processes. Matching the same provider and service reduces distortion from provider and service mix.

Medicare comparisons use the fee schedule that would price the service for that provider, including IPPS, OPPS, ASC, clinical laboratory, and physician fee schedules as applicable.

Aggregation

Rates are reduced to a median for each provider and billing code.
Each code takes the median across providers in the employer's city.
Per-code plan-to-market and plan-to-Medicare ratios roll up as medians across codes.

The headline versus-market result is therefore the median code-level difference between the plan and what other carriers pay the same providers for the same services in the same city.

Limitations

Reports use payer-published rates, which may include stale or out-of-network entries.
The public report reflects the employer's headquarters market, not every employee location.
Benchmark coverage varies by provider and code; unmatched codes are excluded from benchmark rollups.
Employer attributes reflect the latest available Form 5500 filing and may lag corporate changes.
This is an analytical benchmark of published prices, not paid claims, plan design, or total cost of care.

Update cadence

The full ingestion, plan resolution, benchmarking, and report-generation pipeline is rerun quarterly against the latest payer files. Each report identifies its data cycle.