Build high-performing networks with competitive rates. Understand provider footprints, identify gaps, benchmark your contracts against competitors, and defend rate decisions with data.
State regulators demand proof of adequate networks, but your internal data is siloed. Where are the gaps? Which specialists are missing? What's the actual driving distance for members?
Your provider relations team needs to know: Are we overpaying this cardiology group? What are BCBS and Aetna offering them? Without visibility, you're negotiating blind.
That hospital is demanding a 7% increase. Is it justified? What are their quality metrics? How do their rates compare to competitors? Due diligence takes weeks because data is scattered.
Visualize your provider footprint by specialty and geography. Identify underserved areas before regulators do. Model member access. Find strategic recruitment targets to fill gaps.
See what other payers are paying the same providers. "BCBS is paying this hospital $16,800 for DRG 470 while we're at $19,200—that's our renegotiation target." CMS transparency gives you the ammunition.
Identify high-quality, cost-effective providers. Build narrow networks. Model member steerage scenarios. Project savings from directing volume to tier 1 facilities.
Overlay CMS quality metrics with rate data. Identify providers delivering high cost with poor outcomes. Build the case for rate reductions or tiering changes based on performance.
Track provider group expansion. See when competitors add new locations. Understand hospital system affiliations. Model the impact of provider consolidation on your network.
Generate network adequacy reports with drive-time analysis, specialty coverage, and member-to-provider ratios. Export for state filings. Defend network composition with data.
Analyze 50+ MSAs or custom service areas. Track provider networks across your entire footprint. Compare performance market-by-market.
See what competitors are paying. Filter by DRG, CPT, facility, specialty. Identify overpayment opportunities. Defend rate positions with data.
Find high-value providers to fill network gaps. Export contact lists. Track recruitment progress. Model network impact of new additions.
Combine rate data with CMS quality scores. Identify high-cost, low-quality outliers. Build performance-based tiering. Support value-based contracts.
Generate network adequacy reports. Drive-time analysis. Specialty coverage maps. Export for state filings. Automate compliance documentation.
Connect to your claims platform, CRM, or analytics tools. Automate rate comparisons. Build custom steerage dashboards. Real-time provider data.
Join our 90-day design partner pilot. See exactly what your competitors are paying. Model your network gaps. Build your next adequacy filing in days, not months.
Request Pilot AccessOr schedule a 15-minute demo: demo@healthdex.com