Post-Adjudication Recovery & Contract Benchmarking
We Audit the Contract,
Not Just the Claims
Your TPA audits whether claims were coded correctly. We audit whether the contracted rates themselves are competitive. No member engagement required — value is realized at the audit and the benchmark.
6,200+
Hospital systems benchmarked
82%
US claim volume covered
0%
Member engagement required
Rate Competitiveness Scorecard
Acme Manufacturing Co.
Q3 2026
Contracted rates index at 112— 12% above peer benchmark.
+3 vs Q2
Quarterly trend
+$1.84M
Annual variance
Key Findings
The Problem
Your TPA audits the claim.
Nobody audits the contract.
Your TPA checks whether claims were coded correctly, bundled properly, and processed against the plan document. What they structurally cannot do is tell you whether the negotiated rate itself is reasonable — because they or their network partner negotiated it. The contracted rate is the allowed amount. They have zero incentive to flag it as excessive.
Unlike pre-care transparency tools that depend on employees shopping for care differently — which hasn’t worked in a decade — our value is realized at the audit and the benchmark, before a single employee opens an app.
“Your TPA says ‘this claim was paid correctly.’ We can tell you ‘this claim was paid correctly — and your contract is wrong.’ Only one of those findings opens a renewal conversation.”
15–30%
Typical overspend for self-insured employers due to pricing opacity
Health Affairs, 2023
3–5×
Price variation for the same procedure at the same hospital
RAND Corporation Hospital Price Transparency Study
22%
Of 2025 ERISA class actions named health plan sponsors — a record pace
DOJ antitrust scrutiny of carrier-aligned benchmarking (AMA v. MultiPlan/Claritev)
What We Deliver
Three Things No TPA
Will Ever Do
01
Contract Benchmarking
We benchmark every contracted rate against peer plans, Medicare, and in-network alternatives. Your quarterly Rate Competitiveness Scorecard shows exactly where your rates stand vs. peers in your metro. Our methodology is published and externally attested — when a CFO asks "how do you know?" we have a documented, verifiable answer.
02
Recovery
Every paid claim audited for billing errors, upcoding, unbundling, and TPA adjudication mistakes. We generate appeal letters with the evidence package your broker needs to file. You only pay when dollars are actually recovered — aligned incentives, not vendor fees.
03
Fiduciary Protection
Under CAA and post-J&J precedent, plan sponsors carry personal liability for paying reasonable prices. We produce the evidentiary record — methodology-attested benchmarks, documented findings, court-ready fiduciary documentation — that demonstrates prudent plan oversight.
Request Your Free Contract Audit
Request Your Free
Contract Audit
Share your most recent utilization report and we will benchmark every contracted rate against peer plans, Medicare, and in-network alternatives — at no cost and with no commitment. You will see exactly where your rates stand before you decide to engage.
- Rate Competitiveness Scorecard showing how your contracted rates compare to peers in your metro.
- Recoverable-dollar estimate with dollarized findings ranked by impact, not a sales pitch.
- Published methodology you can audit — transparent, externally attested, verifiable.
The Engagement
From your first report
to your next renewal.
01 — RECEIVE
You share your data
Utilization reports and claims files from your broker or TPA. First analysis within one week of data receipt. No data infrastructure required.
02 — BENCHMARK
We audit the contract
Every contracted rate benchmarked against peer plans, Medicare, and in-network alternatives. Every claim checked for errors, upcoding, and adjudication mistakes. Published methodology, externally attested.
03 — SCORECARD
Your Rate Competitiveness Scorecard
One page, one headline number. Where your contracted rates stand vs. peers in your metro, with dollarized findings ranked by impact. The artifact a broker hands a CFO.
04 — RECOVER
Appeal letters and evidence
For every finding, we generate the appeal letter and evidence package. Your broker files. You only pay when dollars are actually recovered.
05 — MONITOR
Quarterly scorecard updates
Every quarter, a fresh scorecard. Rate trends tracked over time. New findings surfaced as MRF data refreshes. Fiduciary documentation maintained.
06 — RENEW
Renewal ammunition
Walk into renewal with documented evidence: here is how your contracted rates compare to peers, here is what we recovered, here is the fiduciary record.
For benefits advisors: Price Intelligence is the finding that changes the renewal conversation permanently. We co-brand reports with your firm and share the variable fee on every dollar recovered.
HIPAA-ready from day one. Signed BAA with infrastructure partners. AES-256 encryption at rest. Row-level data isolation. All claims data handled under Business Associate Agreements that meet carrier security requirements.
Our methodology is published.
Theirs isn’t.
When a CFO asks “how do you know this rate is above peer?” we have a documented, verifiable answer — normalization rules, peer-group definitions, data currency stamps, and external attestation. That is the difference between an opinion and a defensible decision.
Under CAA and post-J&J precedent, plan sponsors carry personal fiduciary liability for paying reasonable prices. The Rate Competitiveness Scorecard is the evidentiary record that demonstrates prudent plan oversight — quarterly, methodology-attested, and court-ready.