Provider Overview

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Overview

The Provider Analysis dashboard allows you to benchmark your pricing against similar organizations in your region and specialty. Requirements for this dashboard include:

• Access to Provider Profiles

If you do not have access to Provider Profiles, please contact your administrator to request access.

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Accessing the Dashboard

You can access this dashboard from your organization’s home screen by clicking the “Provider Analysis and Peer Comparison” card.

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Filters and Navigation

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Navigation

The dashboard is organized into two primary sections:

• Provider Overview: High-level insights and market positioning for your provider organization
• Competitor View: Detailed comparisons against specific competitor organizations in your market

You can use the navigation list on the left side of the filter bar to jump between these sections.

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Filtering Your Analysis

The filter bar at the top of the dashboard allows you to refine your analysis based on specific criteria. You can filter by provider, market, payer, network, billing class, and care setting. These filters apply across dashboard views in your session, allowing you to maintain a consistent analysis context as you navigate. Filters apply to all tables at once, so filtering by a payer like UHC narrows the Contract Percentiles, fee schedule, and market tables to that payer. Billing Class vs. Setting: Billing Class refers to how the service is billed (professional vs. institutional), while Setting refers to where care is delivered (inpatient/facility vs. outpatient/non-facility). They are independent filters. Available Filters:

• Provider: Select specific providers to analyze their pricing data.
• Payer: Filter by specific insurance payers to see how your rates compare against them.
• Network: Filter by network type (e.g., in-network vs. out-of-network) to understand how your rates perform in different contexts.
• Billing Class: Filter by billing classification (e.g., professional vs. institutional) to analyze specific types of services.
• Setting: Filter by care setting (e.g., inpatient (facility) vs. outpatient (non-facility)) to see how your rates compare in different healthcare environments.

To add or change a filter, click the filter dropdown and select the desired criteria. The dashboard automatically updates to reflect your selections, so you can see how your provider’s rates compare against peers under the specified conditions.

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Exporting Your Data

You can export data from any table in the dashboard by clicking the three-dot menu in the top-right corner of the table and selecting “Download.” This lets you download the data in CSV, Excel, PDF, or PNG format for further analysis or reporting. You can then choose your download format (CSV, Excel, PDF, or PNG) and click “Download” to save the file to your computer. Tip for exporting data:

• Always select “Exclude Hidden Columns” if you have applied filters to ensure you only download the relevant data.

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Dashboard Components

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Contract Percentiles Table

The Contract Percentiles table is an at-a-glance view of how you’re performing against peers, broken down by billing code group and payer:

• BCBS (Blue Cross Blue Shield)
• Cigna
• Aetna
• UHC (UnitedHealthcare)
• Regional payers

Regional aggregates smaller or local payers in your market into a single column. Each row represents a specific billing code group (such as surgical procedures, imaging, or office visits), while columns show the contract percentile for each payer. The percentile indicates where your negotiated rate falls within the market distribution. For example, higher percentiles mean your rates are above most competitors in the market. Color-coded percentile values provide quick visual performance indicators: green highlights above-market rates (higher percentiles), while red indicates below-market rates (lower percentiles). This helps you quickly identify which payer contracts and billing code groups are performing well versus those that may need attention during future negotiations.

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Selected Provider’s Fee Schedule

This table displays your provider’s current contracted rates for various payers. Each row represents a specific contract with detailed information including:

• Payer Name: The insurance company name
• Billing Code: The specific CPT or procedure code
• Mod: Modifier codes that affect reimbursement
• % of Current CMS: Your rate expressed as a percentage of Medicare rates. Rates are expressed as a percentage of the Medicare-allowed amount, so 150% means the contract pays 1.5 times what Medicare would.
• Display Rate: The actual dollar amount for the procedure

This table serves as a quick reference guide to your active contracts, making it easy to compare how different payers reimburse for the same procedure. You can see at a glance which payers offer rates closest to or furthest from Medicare benchmarks, helping you understand your overall payer mix performance. How to use this: Scan for payers paying well below your other contracts on the same code — those are the lines to prioritize in your next negotiation cycle.

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Market % of Medicare

This table compares your provider’s rate (Provider % of CMS) against the full market distribution at each percentile level, broken down by market, payer, and billing code group. The rows are organized as an expandable hierarchy. You can expand or collapse each level to drill from your provider organization, down through market and payer, to a specific billing code group. Two context rows at the top show Billing Class (for example, professional) and Setting (for example, outpatient), reflecting the active filters. Columns:

• Provider Name — your provider organization.
• CBSA Name — the market (Core-Based Statistical Area).
• Payer Group — payer aggregation (Aetna, Cigna, UHC, etc.).
• Group — billing code group.
• Provider % of CMS — your rate as a percentage of the Medicare-allowed amount.
• 5th, 25th, Median, 75th, 95th Percentile — the market distribution at each percentile, expressed as % of CMS.
• Provider Market Percentile — where your provider falls within that market distribution.

How to use this: This view shows not just where your rate sits, but how wide the market spread is at each percentile. Use the 75th or 95th percentile column to see what top performers are actually getting paid for a given code group, then set realistic negotiation targets from that evidence.