Know where you stand with your payers.
Locality Anchored Benchmarking compares your contracted rates to what payers actually pay other providers in your geography — by CPT, with confidence flags per finding. Use it for negotiations, appeals, payer mix decisions, or to establish a baseline you can monitor over time.
Per analysis. Five-day delivery.
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.
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, with confidence flags per finding. The deliverable is a defensible document you can take into any payer conversation.
A defensible analysis document, not a dashboard.
Category rollup with leverage opportunity
Executive view showing where your rates stand against the market by procedure category, with confidence-weighted variance and annual revenue opportunity.
Line-level CPT analysis
Every CPT analyzed with current rate, locality benchmark, market percentiles (p25/p50/p75/p90), confidence rating, and dollar impact.
Top opportunities
Curated ranking of the highest-leverage codes with specific recommended asks and risk notes per code.
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.
Annual revenue gap at p75
$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. In a 15-minute walkthrough we’ll show you the complete file and what your own practice’s analysis would surface.
Locality Anchored Benchmarking
Multi-source rate benchmarking, anchored to your specific geography.
You share your contracts and recent claims data. PDFs, CSV exports from your PM system — we handle the variability across Athena, eClinicalWorks, Tebra, and other systems.
We extract your contracted rates and analyze them against locality benchmarks. Rates are anchored to your specific MSA, confidence-weighted across multiple data sources, and ranked by both rate gap and dollar impact.
You receive a defensible analysis document within five days. Excel format, structured for use in payer negotiations, underpayment appeals, or ongoing rate monitoring.
Per analysis. No subscription required.
Built for two audiences.
How an analysis comes together.
- 01
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.
- 02
Share your contracts and claims data
Send your payer contracts and a recent claims export. We handle the variability across Athena, eClinicalWorks, Tebra, AdvancedMD, and other systems.
- 03
Receive your analysis in five business days
A defensible analysis document delivered in Excel, structured for payer negotiations, underpayment appeals, or ongoing rate monitoring.
A short list.
Everything required to begin an analysis.
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, plus the contracts and a recent claims export.
A 15- or 30-minute slot
Time for the initial walkthrough so we can scope the analysis to what you need answered.