To be competitive in the group and individual markets, Blue Plans need to create provider networks that offer members choice while reducing costs through effective reimbursement rates. Machine-readable files (MRFs) offer Plan leaders the ability to understand real-time market positions – before they step foot into network negotiations.

Blue Health Intelligence® (BHI®) recently completed a proof-of-concept project with Blue Cross Blue Shield Association. We found that Blue Plans were competitive, if not favorable,
on network breadth across the five markets analyzed. However, rate positions varied dramatically by market and by service type.

But simply comparing rates code by code or by select in-network files isn’t enough to understand market positions. Through identifying networks and coupling rates with
Plan-specific claims, BHI can calculate observed costs¹ across payers to help Plans identify the most critical areas of market opportunity. For example, within one market, the costs of office visits (CPTs 99211-99215) were observed across the top 10 providers.

Using Blue Plan claims data, BHI can identify specific services that drive market positioning.

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Access to MRF data empowers Plan leaders with comprehensive market intelligence that helps them optimize market positioning and seize competitive opportunities in provider negotiations. Get more information today.