EarnestMD turns insurers’ own published rate data into negotiation-ready intelligence. We show you exactly what comparable providers are paid by the same payers for the same procedures — and build the case that wins the increase.
The problem
The insurer sits on the complete picture of what every provider in your market is paid. You see one contract: your own. That asymmetry is the whole game.
The payer knows what every provider in your market is paid. You see only your own contract. That asymmetry sets the price.
Most contracts roll over untouched for years while the market moves. Without a benchmark, you can't tell whether you're at, above, or well below the going rate.
"We'd like a raise" loses. "Comparable groups in this market are paid 22% more by your plan for these exact codes" is a different conversation.
What we deliver
Three things land on your desk: the benchmark, the strategy, and the document you hand the payer.
Your contracted rates set against comparable providers — by payer, by CPT, by site of service. The exact gap, quantified.
A rate-gap and conversion-factor model showing precisely where you're underpaid and what closing the gap is worth in annual dollars.
A sanitized market-position document you can put directly in front of the insurer — your case, in their language, without exposing your strategy.
How it works
You give us your NPIs, the CPT codes that drive your revenue, and the payers that matter. No claims data required.
We draw on the negotiated rates payers are federally required to disclose, isolating the exact figures for your providers and comparable peers.
Your rates are compared against peer-group tiers across every relevant payer and site of service, with the gaps quantified in dollars.
You get a confidential strategy report and a payer-facing proposal — the complete case, ready for the negotiating table.
The data
Since 2022, every commercial insurer has been federally required to publish its negotiated rates. In theory that data is public. In practice it’s vast, fragmented, and unusable raw — which is why most rate benchmarking still runs on guesswork and stale surveys.
We’ve done the hard work of turning that disclosure into clean, comparable benchmarks — for your specialty, your codes, and your market — across the major commercial payers.
Who it’s for
Rate dynamics differ sharply by specialty — conversion factors, site of service, facility fees. Our models are built per specialty, not one-size-fits-all.
Selected work
Engagements are confidential, so the details below are anonymized. The pattern is the same: find the gap, quantify it, arm the negotiation.
We benchmarked the group's ASA conversion factor against regional peers contracted with the same insurer, surfaced a material gap on the highest-volume codes, and produced both an internal strategy model and a sanitized proposal for the payer.
A site-of-service analysis quantified office vs. hospital-outpatient economics across professional and facility fees — showing the practice, the facility, and the combined health system what each procedure is actually worth in each setting.
We pulled negotiated rates for the group's highest-volume surgical CPT codes across every major commercial payer, exposing which contracts trailed the market and by how much.
Get in touch
Tell us a little about your practice. We’ll tell you whether there’s a payer gap worth chasing — before you commit to anything.
FAQ
From the negotiated-rate disclosures every commercial insurer has been required to publish under the federal Transparency in Coverage rule since July 2022. It is public data — the value is in turning it into clean, comparable, specialty-specific benchmarks.
The source data is public by federal mandate. Your own rates, volumes, and strategy stay confidential — that analysis lives only in the internal report. The document that goes to the payer is deliberately sanitized to make your market-position case without revealing your hand.
Just your provider NPIs, the CPT codes that drive your revenue, and which payers you care about. We do not need your claims data or your existing contracts to produce a benchmark.
UnitedHealthcare, BlueCross BlueShield (state and national plans), Aetna, and Cigna. Humana exited the commercial market and no longer publishes commercial rates, so they are not available from any source.
A focused engagement is a matter of days, not weeks. We scope tightly to your providers, codes, and payers, so nothing waits on work you don't need.
Send us your specialty and your top payers. We’ll tell you whether there’s a gap worth chasing — before you commit to anything.