FairChex incorporates objective cost data which allows us to provide detailed figures that are facility and procedure specific. FairChex can also be tailored to reflect actual payer experience, providing payers an unprecedented view of claims experience blended with market leading quality ratings.
Reference Based Pricing Rate
This methodology shows the ‘Targeted Payment’ in FairChex as a fixed reference based reimbursement reflective of a plan document.
Targeted Payment Rate
This methodology shows the ‘Targeted Payment’ in FairChex as a recommended starting point for negotiations for those clients actively working with providers to establish fair rates prior to a procedure.
Average Allowed Rate
This methodology shows the ‘Targeted Payment’ in FairChex as a reflection of actual Client paid claims experience.
While costs make up 80% of the projected savings, variances in quality represent the other 20%. Higher quality facilities pass on less of a ‘hidden surcharge’ for medical errors, have better outcomes of care and fewer re-admission rates for long term savings and overall peace of mind for members.
The quality data in FairChex is provided by Comparion Medical Analytics, a leader in medical quality ratings. They factor mortality and complication rates, core processes, patient safety and patient satisfaction.