Data iSight Methodology
The most defensible, transparent way to value non-contracted medical claims
Why Data iSight is the right choice for healthcare payors
Launched in 2007, the Data iSight methodology was developed out of a need for healthcare payors to have a means to reprice non-contracted charges – fairly and effectively. Trusted by over 100 payors*, Data iSight is patented and validated by statisticians as effective and fair all while delivering deep savings on non-contracted claims with wide provider acceptance. By applying national benchmarking, regional wage indexing and geographic adjustment among other methods, it allows for the optimal reimbursement compared to Usual and Customary and Medicare-Based pricing.
Accepted
Data iSight is accepted by providers 96% of the time and facilities 93% of the time, making it a defensible methodology for payors. The results are repeatable and consistent, and they also address common provider objections.
Flexible
Data iSight may be used by self-insured and insured plans and may be configured to apply only to specific claim types, with or without negotiation on appeal, and with or without patient advocacy. It may be supported in plan documents as a benefit limit, or used as a cost management strategy.
Transparent
Data iSight’s high acceptance rate is aided by online transparency for all audiences: payors, providers and plan members. Each may log into our online portal and uniformly review how reductions were calculated, thereby lessening appeals.
A better reference for pricing
There is a growing trend among healthcare payors to base reimbursement for non-contracted claims on Medicare reimbursement rates, under the name of Reference-Based Pricing. The problem is, Medicare is not only a flawed valuation for many healthcare services, but it also can deliver unintended consequences. The better measure is one that more directly ties to a provider’s own costs.
Strike a balance
Is your pricing strategy for non-contracted claims too aggressive or too conservative? Maximize savings and minimize balance-billing with fair reimbursement.
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*According to FY 2021 data.