Find the payer rates worth challenging — before your next contract conversation.
Locality Anchored Benchmarking compares your contracted rates to what payers actually pay other providers in your geography — by CPT, with a confidence rating on every finding. So you know exactly where you stand before a negotiation, an appeal, or a payer mix decision.
Per analysis. No subscription. Delivered in five business days.
Your payer knows exactly what your peers are paid. Until now, you didn't.
Insurance companies maintain detailed records of every rate they pay to every provider in your market. When they sit down to negotiate your contract — or when they unilaterally adjust your fee schedule — they know exactly where you fall in the distribution. You don't. And although payers have been required to publish their negotiated rates since 2022, an MGMA poll found only 18% of medical groups actually use that data in negotiations.
PayerBlueprint closes that information asymmetry. We map your contracted rates against what payers pay other providers in your specific locality, line by line, by CPT. The deliverable is a defensible document you can take into any payer conversation.
A defensible analysis document, not a dashboard.
Practice summary with category rollup
Executive view of where your rates stand by procedure category, with your top revenue opportunities ranked by annual dollar impact.
Line-level CPT analysis
Every CPT analyzed with current rate, locality benchmark, market percentiles (p25/p50/p75/p90), confidence rating, and dollar impact.
Offer scenario model
Floor, target, and anchor rates for each priority code, with projected revenue at any level of payer concession — the corridor you negotiate inside.
Methodology and sources
Transparent documentation of how every benchmark was derived, defensible under direct payer challenge.
See exactly what you receive.
Below is a real analysis for a fictional practice — Lone Star Primary Care, a Family Medicine group in the Dallas–Fort Worth metro — benchmarked against United Healthcare’s commercial rates. Every figure is illustrative, but the structure is exactly what we deliver. The benchmark defines your defensible negotiation corridor — floor, target, and anchor — not a guaranteed payer concession.
Illustrative p75 scenario — annual
$112,400
United Healthcare contract is below market for 10 of 15 analyzed codes. E&M office visits (99213–99215) sit in the p25–p50 range — paid less than half of comparable DFW primary care practices by this payer. Chronic care (99490) and transitional care (99495) are the strongest opportunities.
Category rollup — all payers combined
| Category | Top codes | Contracted (% of MC) | p75 target | Annual gap | Position |
|---|---|---|---|---|---|
| E&M (Office Visits) | 99213, 99214, 99215 | 0.95 | 1.165 | $144,340 | p25–p50 |
| Preventive Care | 99396, 99395 | 1.018 | 1.115 | $18,909 | p50–p75 |
| In-Office Procedures | 93000, 94010, 20610 | 1.025 | 1.163 | $5,899 | p25–p50 |
| Chronic Care Mgmt | 99490 | 0.92 | 1.2 | $3,415 | Below p25 |
| Transitional Care | 99495 | 0.935 | 1.22 | $4,190 | Below p25 |
| Other | J0696, 99213-25 | 0.994 | 1.159 | $4,586 | p25–p50 |
Top 5 revenue opportunities — ranked by annual gap
| CPT | Description | Annual vol. | Contracted | p75 target | Gap at p75 |
|---|---|---|---|---|---|
| 99214 | Office visit, established, moderate complexity | 3,210 | 0.952 | 1.18 | $81,891 |
| 99213 | Office visit, established, low complexity | 2,840 | 0.945 | 1.14 | $41,345 |
| 99215 | Office visit, established, high complexity | 580 | 0.96 | 1.2 | $21,105 |
| 99204 | Office visit, new patient, moderate complexity | 510 | 0.968 | 1.17 | $15,448 |
| 99396 | Preventive visit, established, 40–64 yrs | 860 | 1.02 | 1.12 | $11,180 |
This is the overview — the full file goes deeper.
Behind every number is documented methodology, MRF source data, confidence flags, and an internal QA checklist. Pick the path that fits where you are.
How an analysis comes together.
Multi-source rate benchmarking, anchored to your specific geography.
- 1
Start with a walkthrough
A short call to understand your practice, your payers, and what you want the analysis to answer. No commitment required to scope the work.
- 2
Share your contracts and data
For a Payer Rate Snapshot, no claims data is needed. For a Practice Benchmark, send your payer contracts and a recent claims export — we handle the variability across Athena, eClinicalWorks, Tebra, AdvancedMD, and other systems.
- 3
Receive your analysis in five business days
We extract your contracted rates and benchmark them against your specific MSA, confidence-weighted across multiple data sources. Delivered in Excel, structured for payer negotiations, underpayment appeals, or ongoing rate monitoring.
How we make the comparisons fair.
A benchmark is only as good as its controls. Industry analyses have found that up to 40% of entries in raw payer transparency files are “zombie rates” — clinically implausible numbers a naive lookup can't detect. Every comparison in a PayerBlueprint analysis is constructed to filter that noise and survive a direct challenge from the payer across the table.
Same payer, same product line
Comparisons are made within the payer and commercial product line, so a narrow-network rate is never held against a broad-PPO benchmark.
Same code, same setting
Each benchmark is specific to the CPT code and place of service — office rates are compared to office rates, not facility rates.
Your geography, not a national average
Benchmarks are anchored to your MSA. Payer rate distributions are local, and a national average hides exactly the variation that matters in a negotiation.
Multiple sources, cross-checked
Payer transparency files, CMS reference data, and market datasets are checked against each other. When sources disagree, the confidence rating goes down — the number doesn't go up.
A confidence rating on every finding
Findings are rated High, Medium, or Low based on in-geography observation counts. Low-confidence findings are flagged as supporting context, never presented as negotiation asks.
Per analysis. No subscription required.
The break-even math is deliberately small: a $1,000 analysis on a code you bill 1,000 times a year pays for itself with a $1.00 per-unit rate improvement. The analysis exists to find gaps many times that size.
Built for two audiences.
What you'll need to start.
Everything required to begin an analysis — and how your data is handled.
Your practice details
NPI, specialty, and locality (MSA). This anchors every benchmark to your specific geography.
A list of your payers
The commercial payers you contract with. For a Practice Benchmark, add the contracts and a recent de-identified claims export.
A 15- or 30-minute slot
Time for the initial walkthrough so we can scope the analysis to what you need answered.
How your data is handled
- Rate analysis needs codes, rates, and volumes — not patient identities. We ask you to de-identify claims exports before sending, and we walk you through it on the scoping call.
- Your data is used only to produce your analysis, retained only while the engagement is active, and deleted on request.
- A Payer Rate Snapshot requires no claims data at all — practice details and one payer's fee schedule are enough to start.
Frequently asked questions.
What is Locality Anchored Benchmarking?
Locality Anchored Benchmarking is PayerBlueprint's method for comparing a practice's contracted payer rates to what the same payers actually pay other providers in the same geography. Every comparison is made by CPT code, anchored to your MSA, and carries a confidence rating — producing evidence you can defend in a payer negotiation.
Where does the benchmark data come from?
Benchmarks are built from the machine-readable files payers must publish monthly under the federal Transparency in Coverage rule, cross-checked against CMS reference data and commercial market datasets. The raw files are enormous, and a large share of raw entries are clinically implausible — extracting clean, local, code-level comparisons is the heavy lifting PayerBlueprint does.
How do you make the rate comparisons fair?
Every comparison is controlled for payer and product line, CPT code, place of service, and geography. Findings backed by fewer in-market observations receive a lower confidence rating and are flagged as supporting context rather than negotiation asks. The methodology section of every deliverable documents how each benchmark was derived.
Do I have to send claims data?
Not to start. The $400 Payer Rate Snapshot uses your fee schedule and public utilization data — no claims export needed. A full Practice Benchmark uses a recent claims export to volume-weight the analysis. We ask you to de-identify it first, because rate analysis needs codes, rates, and volumes — not patient identities.
What does the $400 Payer Rate Snapshot tell me?
It answers one question: is there enough evidence of a rate problem to justify a deeper review? You get a local comparison for one payer across 10–15 priority CPTs and a clear recommendation — negotiate now, hold, or run a full Practice Benchmark. The $400 is credited if you upgrade.
How is this different from benchmarking against Medicare percentages or national averages?
A Medicare multiple tells you where you stand against a government fee schedule, not what commercial payers actually pay your peers. Milliman's 2025 benchmarking puts commercial physician rates near 148% of Medicare nationally — but metros within a single state can differ by more than 100 points. PayerBlueprint benchmarks against real commercial rates in your specific MSA — the distribution your payer actually sees.
Do you negotiate with payers on our behalf?
No — PayerBlueprint produces the analysis, not the negotiation. The deliverable is structured so a practice administrator or a professional negotiator can act on it directly: ranked opportunities, specific per-code asks, and an offer-scenario model. Many negotiation consultants use PayerBlueprint as the analytical backbone of their client engagements.
What if the analysis shows my rates are already competitive?
Then you've learned that before spending months on a negotiation with little upside. You keep a documented baseline for monitoring future fee-schedule changes, and the Snapshot's recommendation would be to hold rather than negotiate. A benchmark that only ever said "you're underpaid" wouldn't be worth defending.