Hospital reimbursement intelligence
Benchmark reimbursement without confusing a public rate with payment truth
QuickIntell connects aggregate public market evidence with a hospital's private contract and 835 or ERA evidence through an assisted analysis. Each layer answers a different financial question.
Designed for
- Revenue cycle leadership
- Finance and revenue integrity
- Payer contracting teams
- Hospital RCM partners
- Medical billing leaders
Evidence model
Four layers of reimbursement truth
Public rates are a market signal. A contract and the adjudicated remit are different evidence layers.
Read the methodology- 01Public evidence
Public hospital benchmark
Hospital-reported rate-file observations, normalized into comparable aggregate cohorts.
- 02Separate phase
Public professional or group benchmark
Transparency in Coverage observations require a distinct provider-group methodology and are not mixed with hospital data.
- 03Private analysis
Signed contract expectation
The provider contract establishes the expected reimbursement after its terms, modifiers, bundles, and setting rules are applied.
- 04Private analysis
Actual 835 adjudication
The 835 or ERA shows the allowed, paid, adjusted, and denied outcome that can be compared with contract expectation.
The decision problem
One rate question often contains four different questions
Hospital teams may see a public rate, a contract term, an expected amount in the patient accounting system, and an allowed or paid amount on a remit. A difference between those values is not automatically an error because each was produced under a different scope and methodology.
A useful reimbursement benchmark keeps those layers separate, makes the comparison cohort explicit, and shows the evidence needed to move from market screening to a reviewable financial decision.
From public signal to private analysis
The assisted workflow narrows a broad rate question into a comparable, traceable review scope.
- 01
Define
Choose the payer, service, setting, market, and decision question.
- 02
Screen
Review a compatible public aggregate and its coverage evidence.
- 03
Model
Apply relevant signed-contract terms to the private claim context.
- 04
Reconcile
Compare expected reimbursement with 835 or ERA adjudication.
- 05
Route
Send explainable exceptions to the right contracting or RCM owner.
Public benchmark and private analysis serve different jobs
| Dimension | Public benchmark | Private assisted analysis |
|---|---|---|
| Primary evidence | Aggregate hospital rate-file observations | Signed payer contract and adjudicated 835 or ERA |
| Primary use | Market screening and prioritization | Expected-versus-actual reimbursement review |
| Visibility | Public, sanitized, aggregate only | Restricted to the agreed secure workflow |
| Can establish underpayment? | No | Only after contract, claim, and remittance validation |
| Output | Percentile distribution and cohort evidence | Reviewable variance context and routing |
A focused pilot begins with a question
The first scope can focus on a payer, contract, service family, market, or recurring adjudication pattern. Qualification establishes the secure data workflow before private files are requested.
Useful scoping inputs
- The business question and decision owner.
- The payer, contract period, facility scope, and care setting.
- The relevant service identifiers, modifiers, and bundle logic.
- The approved source for expected contract calculations.
- The 835 or ERA evidence used for actual adjudication.
- The review, correction, appeal, and escalation rules.
Hospital reimbursement benchmarking FAQ
Explore public benchmarksDoes a public negotiated rate show what our hospital should be paid?
No. A public rate-file observation is a market signal. Expected reimbursement depends on the signed contract and claim facts, while the 835 or ERA shows the adjudicated outcome.
Can public reimbursement benchmarks prove underpayment?
No. A benchmark can help prioritize review, but a potential underpayment must be validated against the applicable contract terms, modifiers, bundles, setting, claim facts, and remittance.
What data is collected through the public contact form?
The public contact form is for business contact and qualification information only. Contracts, remits, claims, and PHI should be transferred only after a secure private workflow is established.
Is this designed only for large health systems?
The assisted workflow can be scoped for hospitals and health systems of different sizes. The useful starting point is a defined payer, service, market, or reimbursement question rather than organization size alone.
Start with one payer, contract, or reimbursement question
Request an assisted scoping conversation. The public form collects business contact information only; private files move through an agreed secure workflow after qualification.