Healthcare Pricing Guide™ (HPG)
U.S. Medical Benchmark and Payer-NPI Level Prices from Transparency in Coverage and Medicare Data
with the largest and most accurate data
available on negotiated medical prices in the U.S.
Due to its sheer size, the wave of payer data beginning in late 2022 will require significant experience with big data to make its way into useful tools at scale. DDI has that experience.
The first user friendly tool from just released Transparency in Coverage files as mandated by CMS,
revealing negotiated prices from all healthcare payers for all services to all medical providers
Calculated Employer HPG Return On Investment is as much as 1,000 to 1
According to the CAA
For self-insured employers and their TPAs:
As an employer, it’s now your responsibility to ensure your health plan is cost-effective. The Consolidated Appropriations Act (CAA) in 2023 will make self-insured employers the fiduciaries for the healthcare services that they purchase. Fiduciaries may consider how the CAA’s ‘covered service provider’ compensation disclosures could inform generally applicable ERISA principles tied to ensuring those vendors are paid reasonable compensation. This also applies to how health plans or third-party administrators had been bargaining for their employer clients. (HR133)
Request a Health Plan Pricing Report Card™ (custom option)
Be in compliance with the No Surprises Act
HPG includes the qualifying payment amount (QPA).
The QPA for every medical service is the basis for determining individual cost sharing for items and services covered by the balance-billing protections in the No Surprises Act (NSA), (CMS)
What is a better benchmark, national prices, local prices, and payer-provider prices?
Why choose, when you can have them all?
Price variability in network negotiated rates is massive, with no correlation to quality. HPG allows you to display national benchmarks, local benchmarks, or line level pricing by payer and provider, incorporating provider quality data from PRS for member navigation or negotiations on quality and price. Local negotiated price variations vary far beyond what the difference would be based on local costs. It's time to lift the veil on healthcare costs, rewarding the best providers at the best prices.
Key Benefits & Features Include
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Save Money, Reduce Healthcare Benefits Costs, by reducing excessive prices paid in your health plan. -
Attract Employees by lessening the need to raise premiums, deductibles & co-pays. -
Covers All Reimbursement Codes, DRG (hospitals), HCPCS (doctors & other providers, including CPT & CDT), ICD codes, & RC (revenue codes). -
Based On Billions of U.S. Negotiated Prices, after thorough quality control checking, using over 100,000 health plan non-duplicate files. -
Highest Quality Providers do not cost more. Use Provider Ranking System™ (PRS) to select high performing providers. -
Be in Compliance with CAA (Consolidated Appropriations Act) & NSA (No Surprises Act). -
Highest Quality Providers do not cost more. Use Provider Ranking System™ (PRS) to select high performing providers.
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Be in Compliance with CAA (Consolidated Appropriations Act) & NSA (No Surprises Act). -
Easily Searchable, using any combination of terms. -
Evidence-Based Data. Objective. Transparent. Real. -
The new standard for Reference Based Pricing (RBP) is the Transparency in Coverage (TiC) Fair Price (Median). -
It is a Fair & Reasonable Price, not depedent on government decisions like Medicare.
More Benefits & Features
- Help Bring Transparency to health benefits.
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Access What Used to be Highly Confidential, secretive information, now at your fingertips. -
U.S. Healthcare Costs Are Double those in other developed countries, without achieving better outcomes. -
The Target for Fair Price is Median Price, or 50%; the quartiles (25% and 75%) indicate that half of all prices are within that range; 90% of prices are within the range from 5% to 95%; any price outside of that is an outlier. -
Also Shows Physician Claims Medicare Approved Amounts, for comparison, from Provider Ranking System™ (PRS). -
Plus List Prices/Billed Amounts, from Provider Ranking System™ (PRS). -
Further Options Available to retrieve individual negotiated prices by provider and/or by health plan.
- Also Shows Physician Claims Medicare Approved Amounts, for comparison, from Provider Ranking System™ (PRS).
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Plus List Prices/Billed Amounts, from Provider Ranking System™ (PRS). -
Further Options Available to retrieve individual negotiated prices by provider and/or by health plan.
Unconditional Guarantee: If for any reason you are not satisfied we will refund your payment for the remainder of your term.