Provider contracting analyst
What a named provider’s contracts look like, from the record.
Before a negotiation, somebody has to establish what a hospital filed for an admission, how it is priced, and how that sits against what payers publish. The agent does the reading and keeps two kinds of number apart.
The job
Is this admission priced as a DRG case rate or some other way? What did the hospital file as its standard charge? What do payers publish for the same procedure in this market, and on what date? The answers live in price-transparency filings and payer rate files that are republished and overwritten. Reading them is slow and mixing them up is easy.
What the agent does
- Reads the filing
- What a hospital filed as its standard charge for an inpatient admission under 45 CFR 180, and what that filer carries at all, so a call that prices something is a call that answers.
- Positions published rates
- What a payer published it pays for a code, positioned against the Medicare fee schedule that anchors it, with professional and technical components split.
- Compares side by side
- Two to four codes under one receipt, each figure with its vintage.
- Checks the stack
- Whether a code pair carries a coding edit, and who a coverage article says may furnish and interpret a code.
What it does not do
- Cross a filed charge with a published rate. They are different kinds of number from different filers and are kept in separate tools on purpose.
- Say what your contract says. It reads the public record. Your contract is evidence only you hold.
- Treat a missing row as permission. No coding edit on file is unknown, never clearance.
How to put it to work
- TODAY · PUBLIC EVIDENCE
Mount the free healthcare world in Claude Code, Codex or any MCP client and ask it how to take this seat. It answers from preserved public record, with a receipt on every figure.
- WITH US · YOUR EVIDENCE
The same seat on your own contracts and remits, with the same tests, dated record and refusal boundaries. Hosted by us or inside your VPC, built alongside your team until your people run it.