01
Contract Scenario Modeling
Test rate structures, fee schedules, and contract terms before signing.
Simulate scenarios, project financial impact, price claims with configurable pricing logic, win negotiations, and stop incorrect or unfair payments.
Contract scenario model · Scenario 1
Regional health system · national carrier · Next 12 months
Current contract
$1,840.0M
Modeled scenario
$1,860.0M
Net change
+$20.0M
+1.1% vs. current
$18.4M will be unreimbursed under the current methodology. Dive deeper to see more.
… and every other facility and service line in the book.
Anyone in healthcare knows payer-provider contracts are complex. A rate isn't the end number — it's just a piece of the story. To know what something will cost in the future, it needs to be simulated using a bill from that provider and the logic the payers use.
We've built a system that takes in claims and simulates payments under configurable logic. That system enables stakeholders to contract with confidence, understand how they are getting paid, and optimize for sustainable profitability.
Built for Payers, Providers, and Benefits Consultants
Test rate structures, fee schedules, and contract terms before signing.
Reprice historical claims under any contract scenario, with configurable pricing logic. Understand how you are getting paid versus what is contracted. Identify issues with billing, chargemasters, underpayments, unfair payments, and more.
Identify underpayments and unfair payments. Understand where your billing is causing denials or underpayments. Use this information to collect from payers.
Negotiated a $25MM increase with a payer that was systematically underpaying
Modeled a $600MM negotiation, identifying payor modeling errors and increasing reimbursement by $5MM+
Modeled a $1B+ renegotiation to have reimbursement reflecting a new ambulatory strategy
Identified coding errors and contract provisions that would otherwise go unnoticed, leading to $3MM in retained revenue