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SAN DIEGO — XiFin, Inc., a leading provider of innovative health care information technologies and services that deliver artificial intelligence (AI)-enabled operational efficiency, interoperability, and simplicity, announced it has significantly enhanced its Payor Rate Transparency Monitor, adding two major payors — Humana and Blue Shield of California (BSCA) — to provide healthcare organizations with deeper insights into in-network contracted rates across millions of payor reported records. Combined with new analytic data and user interface enhancements, the Payor Rate Transparency Monitor furthers XiFin’s commitment to empowering healthcare providers with the tools they need to navigate complex reimbursement landscapes and enhance their financial performance.
Payor Rate Transparency Monitor: A Critical Tool for Navigating Payor Behavior
The new release of the XiFin Payor Rate Transparency Monitor, the first-of-its-kind online resource, now offers a more comprehensive view of the payor landscape, through interactive visualizations drawn from 7 terabytes of data reported by payors pursuant to the CMS Transparency in Coverage (TiC) Final Rule. These additions, along with significant interface upgrades, make it easier for healthcare organizations to access and compare payor data in real time.
“While payor rate data is publicly available, it is notoriously difficult to gather, process, and interpret,” said Jeff Carmichael, XiFin senior vice president, engineering. “XiFin’s Monitor offers a unique solution, enabling users to efficiently compare payor rates and trends across the industry. The addition of Humana and Blue Shield of California is a major step forward in our goal of providing healthcare organizations with the comprehensive data they need to thrive.”
Expansion with Humana and BSCA
The Payor Rate Transparency Monitor has expanded its capabilities with the addition of Humana and BSCA, processing over 718,000 files and analyzing 7 terabytes of data — 700 times more files than previous payors like UHC, Aetna, and Cigna had over the past 10 months combined. This tool is now available for laboratories and diagnostics providers, as well as pharmacies, making it an invaluable resource for healthcare providers looking to refine reimbursement strategies and maintain a competitive edge.
In addition to this expanded reach, the Monitor now boasts faster load times, responsive formatting for mobile and desktop devices, and the option to select specific payors for targeted analysis. These enhancements streamline tracking payor behavior, supporting more effective decision-making in contract negotiations and revenue cycle management.
Comprehensive Resources in the XiFin Payor Intelligence Hub
In addition to the release of the Payor Rate Transparency Monitor 2.0, XiFin has launched the Payor Intelligence Hub — a curated collection of resources designed to inform market access and payor relations strategies that enable providers to stay current, compliant, and competitive with constantly changing payor behaviors. The hub includes the latest billing news, white papers, blogs, and webinars, offering healthcare organizations a full suite of resources to fortify their market access strategies for success.
The hub features a monthly Spotlight on Payor Behavior; this month showcases a summary extracted from XiFin data of reason code denial rates for Medicare and Medicare Advantage plans. The data reveals marked shifts in the reason codes Medicare Advantage plans use to deny claims, even as the reason code usage for Medicare denials remains relatively consistent across years. For instance, those attributed to non-covered items shifted from primarily CO-50 in 2019 to CO-96 in 2024.
“Payors are continuously adapting their utilization management practices, which can make it difficult for providers to be paid for the work they do; it is essential for healthcare providers to stay informed, especially when it comes to denials practices,” said XiFin senior director, revenue and payor optimization Clarisa Blattner. “The Payor Intelligence Hub is designed to deliver timely and actionable insights, empowering healthcare organizations to stay ahead of these changes.”
The hub also features the newly released 2024 Payor Denial Impact Report, which provides an in-depth analysis of millions of claims from XiFin customers. The report highlights key denial trends and appeal strategies, giving healthcare organizations the information they need to reduce denials, improve cash collections, and improve financial outcomes.
XiFin is committed to further expanding the Payor Intelligence Hub, including the Payor Rate Transparency Monitor and the Pharmacy Payor Rate Transparency Monitor, with plans to add more payors and data types in the coming months. As payors continue to evolve and adapt, XiFin’s tools provide healthcare providers with the resources needed to stay competitive and achieve financial sustainability.
