Claims data analysis that shows whether your customers are getting paid

Are your customers getting paid? How and by whom? Utilization, realized payment, and denial analysis from adjudicated claims data, with documented conventions and independently recomputed figures.

Product
Claims Intelligence
Price
From $5,000, plus data at cost
Timeline
Two business days from data receipt
Scope this engagement

What payers actually paid

Published policy and realized payment routinely disagree. Claims Intelligence analyzes real adjudicated claims, from your remittance extracts or from public data we procure, and turns them into the utilization and payment picture your coverage strategy should be standing on. That picture covers units over time, realized payment against the allowable, payer mix, denial and appeal patterns, and the inflection points that follow fee schedule changes. The pipeline computes the numbers; an expert who has worked the payer side of them tells you what they mean.

In one recent build, this analysis quantified a 13x quarterly growth inflection after new MAC fee schedules took effect and showed Medicare paying a consistent 80% of the allowable, the kind of numbers that change a payer conversation.

What lands in your inbox

  • Interactive claims analysis with utilization curves, payment distributions, payer mix, and geographic spread
  • Realized payment vs. allowable analysis by payer and site of service
  • Documented computation conventions, with grain, dedup rules, and exclusions stated up front
  • Independent recompute verification, with every figure re-derived by a second pass before it ships
  • Findings memo, written with the engagement's senior expert, connecting the numbers to coverage and pricing strategy

Bring your data, or we bring ours

Client data, from $5,000

Your remits and extracts

IQVIA remittance extracts, clearinghouse data, internal sales and claims records. Fastest route to realized-payment truth, because the adjudication outcomes are in the data.

Praxa-procured, from $5,000 plus data at cost

Public and licensed data

Medicare public use files, state all-payer claims databases, and licensed sources where scope justifies them. The market-level view of who is billing your codes, where, and what they collected.

Bought alongside a Vantage Landscape on your own remittance data, the module is $2,500. Quarterly refresh attaches to a Vantage Live subscription, turning a one-time analysis into a living utilization curve your dossiers and payer meetings can cite.

Asked and answered

Comparable analyses start around $10,000 and the claims platforms cost more than that per year. What is the catch?

There is no catch; there is a pipeline. Computation conventions are documented, every figure is independently recomputed, and the verification trail ships with the analysis. The price reflects our cost structure; the deliverable gives up nothing.

What data do we need to provide?

For the client-data variant, any adjudicated claims or remittance extract works, in whatever format your biller or data vendor produces. We handle the cleanup and document every convention we apply.

How do you handle protected health information?

The analysis runs on de-identified or limited data sets. Data handling terms, including destruction on completion, are written into the engagement agreement.

Ready to scope it?

Thirty minutes fixes the question, the deliverable, and the price. Kickoff within days of signature.

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