Benchmark API
Coming Q3 2026Your Pre-Payment Audit,
Made Smarter.
Real-time peer-rate comparison for any claim during adjudication review. Every claim your team flags, we tell you in real time how that contracted rate compares to what other payers paid the same provider for the same procedure code.
That converts your pre-pay review from “this looks high” to “this is X% above the cross-payer benchmark for this provider” — which is the difference between an opinion and a defensible decision.
Built For
TPAs
Mid-tier TPAs competing against larger competitors with internal benchmarking. Add peer-rate context to your pre-payment review without building a data infrastructure team.
Advocacy Platforms
Lantern, Transcarent, and Centers of Excellence companies whose value proposition depends on data they don't fully control. Own the benchmark.
Payment Integrity Vendors
Zelis, Cotiviti, Claritev, and regional competitors expanding data assets. Two integrations are the threshold where the API becomes a category.
API Preview
Sub-500ms Per Claim
One API call returns the complete peer-rate context for any CPT at any provider. Response includes peer percentiles, Medicare multiple, variance percentage, and data currency.
Request
GET /v1/benchmark
?cpt=73721
&provider_npi=1234567890
&metro=houston
&payer=cigna
Authorization: Bearer sk_live_...Response
{
"cpt": "73721",
"description": "MRI knee without contrast",
"provider": "Memorial Hermann Memorial City",
"metro": "houston",
"your_rate": 2847,
"peer_rates": {
"p25": 980,
"p50": 1120,
"p75": 1640
},
"medicare_rate": 347,
"medicare_multiple": 8.2,
"peer_median_multiple": 2.9,
"variance_pct": 154,
"data_currency": "2026-10-15",
"methodology_version": "2.1"
}Roadmap
Q3 2026
API spec shipped
Sub-500ms response SLA, authentication architecture for TPA integration, billable-event metering.
Q4 2026
First TPA integration
Proof-of-concept with a mid-tier TPA in the 50K-200K covered-lives range.
H1 2027
Second integration
Payment integrity vendor integration. Two integrations = the API becomes a category, not a custom build.
Get Early Access
If you operate a pre-payment audit workflow and want to add peer-rate context to your adjudication review, let’s talk.
Or reach us at api@medicalbills.com