Painting the Bridge: How HexIQ Makes it Possible to Download Negotiated Rate Data for Pulse Medical Subscribers

On the first of every month, payers across the United States release massive datasets of Machine Readable Files (MRFs) that contain every rate negotiated with every provider, for every CPTⓇ code and modifier combination in every service setting, across every plan they offer.

To put this in perspective, Anthem releases a payer dataset that is more than double the size of the entire Netflix HD catalog every month.

Insurance companies are not doing this to help consumers better understand the costs associated with their health care. Instead, payers are complying with the Transparency in Coverage rules that went into effect on July 1, 2022. 

The spirit of the law is to allow third parties, including researchers and app developers like us, to shine a light on historically murky pricing structures and to benefit practitioners and consumers by disrupting the status quo.

At HexIQ, we’re leveling the playing field between medical practices and private payers by providing an easy way for practices to download and analyze granular reimbursement rate data within their chosen specialty and geographical region.

We’re attacking the problem by taking a page from the Highway and Transportation District’s playbook for maintaining the Golden Gate Bridge in San Francisco. Legend has it that a “revered and rugged” group of ironworkers, painters, and laborers engage in a daily battle to keep the bridge in tip-top shape. It’s a constant project that requires daily diligence and attention to detail. Similarly, the brilliant and scrappy Pulse Medical team at HexIQ attends to our proverbial bridge with valiant care in order to provide negotiated rate transparency for all at an accessible price point.

Keeping with the metaphor, imagine that each month spans the length of the bridge. Upon entry, on the first of every month, we begin the process by generating a comprehensive map of providers (by NPI) for every supported payer in the Pulse Medical platform. As we progress across our bridge, we prioritize the loading of the most recent data of interest available for our subscribers. From there, we prioritize new requests from current subscribers for any payers they have licensed. Finally, the team loads negotiated rate data from as many payers as possible in order to paint and polish more and more of the bridge. When the month is over, our work begins anew.

Annual subscriptions are available for $1,000 per payer.