ClearRate for Employers
Stop overpaying your carrier. Find out where, by how much, and what to do about it.
ClearRate parses your plan’s federal Transparency in Coverage files and ranks the medical codes where your contracted rates sit materially above peer markets — sized in dollars, not abstract percentiles. Walk into your next carrier renewal with auditable receipts.
Request a scoped pilot › See real findingsThe problem we solve
The official answer
Since 2022, federal rule has required your health plan to publish every negotiated rate as a downloadable file. The files exist. They are publicly available. They are also gigabyte-scale JSON archives — legally complete but practically unusable without specialized tooling.
What ClearRate delivers
We parse your plan’s actual Transparency in Coverage files, identify the medical codes where your rates sit materially above peer benchmarks, and size the renewal opportunity in dollars — with every quoted figure linked back to the source file and publication date.
Real findings, real federal files
Two illustrative case studies from real federal Machine-Readable Files. Branmoor ran its streaming parser end-to-end against each, producing the kind of analysis a self-insured employer should see before sitting down with their carrier.
Case study · BCBSTN BlueCard PPO
Cracker Barrel
Top-billed codes are radiology (ankle, elbow, knee x-rays). Rate spread within the same network reaches 14× on specialty codes like CPT 37286 (tibial vascular stenting) and 8× on CPT 43220 (esophagoscopy with balloon dilation). High-volume codes have tight distributions; the renegotiation opportunity sits further down the volume curve.
Case study · Cigna National PPO
International Paper
A national carrier’s file is dramatically larger than a regional Blue’s. ClearRate’s sampling strategy surfaces the same renegotiation signal at 5% sample that a brute-force parse would yield at 100% — with the geographic normalization required to compare a Memphis facility against a Mobile one fairly.
What we’ve learned (so your team doesn’t learn it the hard way)
Most Transparency-in-Coverage analyses fail at the same handful of places. The lessons baked into ClearRate:
- 01Volume is not opportunity. The highest-billed codes typically have tight rate distributions. The renegotiation dollars live further down the volume curve where carriers don’t expect scrutiny.
- 02Rate type matters. Published “rates” mix specific dollar amounts, fee-schedule lookups (e.g., 150% of Medicare), percentages of billed charges, and bundled/case rates. A naïve dollar comparison is misleading. ClearRate normalizes.
- 03Carrier network ≠ your network. Self-insured employers typically access the carrier’s negotiated network on behalf of all its ASO clients. Your “rates” are the carrier’s rates. The leverage point is where those rates sit in the carrier’s broader book.
- 04Geography is the hidden variable. A regional Blues file and a national carrier’s file can’t be compared head-to-head without normalizing for where the providers actually practice.
- 05File architecture varies. One BlueCard PPO file may reference 285 distinct network plan codes across 19 options. Whose rates apply to whose employees is not obvious in the raw data.
How a ClearRate engagement runs
Step 01
You share your plan
Carrier name, plan identifier, and the population you cover. We locate your plan’s Transparency in Coverage file directly from federal disclosures.
Step 02
We parse the source
Our streaming parser processes your file end-to-end — 400–700K rows/second sustained, under 1 GB peak memory regardless of input size.
Step 03
We identify the spread
Rate distribution analysis at the (code × provider) level, normalized for rate type, geography, and network scope. The codes worth renegotiating surface.
Step 04
You get receipts
A deliverable that fits in an audit committee binder: dollar-sized findings, source-file citations on every number, prioritized recommendations.
Who this is for
- Self-insured employer benefits leadership — preparing for carrier renewal, audit committee, or board-level cost review
- Benefits consultants and broker advisory teams — Mercer, Aon, WTW, regional independents bringing differentiated analysis to client renewals
- Health-plan brokers managing self-funded books who want to substantiate the “your carrier is overcharging” conversation with primary-source data
- Third-party administrators defending against client claims of suboptimal network steerage
Find your spread before your next renewal.
Engagements are scoped per plan and priced per engagement. Initial audits typically deliver in 2–3 weeks. We’ll tell you within an hour of seeing your carrier and plan size whether your file is suitable for the analysis.
Request a scoped pilot ›