QUARX Logo
QUARX
Biopharma Consulting
Back to Products
CHORD icon

CHORD (Cross-channel Hospital Outpatient Reimbursement Database)

is a comprehensive analytics-ready database of payer-provider negotiated rates

To optimize both payer and provider contracting strategy for drugs administered in the hospital outpatient setting through the analysis of

Variation in negotiated rates for competing drugs across payers and providers

Differential reimbursement across competing drugs

Relationship between NCR and product preference

Provider discounts to position a favorable NCR vis-à-vis competition

Level of homogeneity in negotiated rates in a Health system

NUMBERS
~1 Billion Records
~6,000 Hospitals
~500 Health Systems
~2,500 Payers
>50,000 Plans
>150,000 Codes
• HCPCS/CPT
• NDC
• APC
• ICD10PCS
Reimbursement Methodology
Fee Schedule | % of Billed Charges | Case Rate | Per Diem
Procedure Modifiers
340B | Drug Waste | Quantity
FEATURES
ANALYTICS READY DATA MODEL
Standardized Clean and Quality Assured Data
Number 1
Number 2
MAXIMUM DATA RESOLUTION
Able to Distinguish Rates for the Same Code at the Same Provider
INTEGRATED HOSPITAL & PRODUCT PROFILES
Augment Rate Data with Key Descriptive Characteristics
Number 3
Number 4
GEOGRAPHIC DRILLDOWN
Compare Rates at Regional and Local Levels Within a State
CLOUD-BASED DASHBOARD ACCESS
Dashboard is Optimized via Cloud Based that Delivers Reports
Number 5
LEVELS

Lookup payer reimbursement rates at any level of Payer, Provider and Geographic granularity

Level 1: Channel
  • • Commercial, Medicare, Medicaid
  • • exchange, Medicaid managed care
  • • and Medicare Advantage
Level 2: Payer
Details at the plan products each payer serves with plan and product
Level 3: Plan
Plan level granularity with each plan type (Aml, I-IRA, PPO, HOS-Sage) etc.)
Level 4: Health System
Reimbursement rates by Health System to identify operational owners, links and Health System
Level 5: Local Geo
Geographic units mapped at multiple levels - State, MSA, HRR, and Local Geographic Areas
Level 6: Hospital
Reimbursement amounts at the hospital level with the maximum geographical resolution in the Database
Analyze payer reimbursement rates to understand
  • • Variation in reimbursement rates across hospitals
  • • Homogeneity of reimbursement rates within a health system
  • • Differential reimbursement across competitive drugs

Payer negotiated rates for all hospital outpatient and inpatient procedures at the plan level

Payer reimbursement methodology by plan, provider and procedure (Fee Schedule vs % Billed Charges, Case Rate, Per Diem etc.)

Negotiated rates for APC based payments

Hospitals that are operationally and technologically integrated (set up with the same Charge Data Master)

Level of uniformity it negotiated rates across Hospitals in a Health System

CHORD's analytic-readiness and accessibility is the result of our systematic and rigorous process of data extraction, curation, mastering, integration and visualization.

Hospital Published Price Transparency Files

Hospital Published Price Transparency Files

Development of custom web-scraping, data validation and ingestion programs to stage Price Transparency Files

Multi-step LLM-based Payer-Plan Mastering

Multi-step LLM-based Payer-Plan Mastering

LLM augmented program to incrementally master payer-plan relationships and establish LoB

Provider Mastering & Hierarchy Mapping

Provider Mastering & Hierarchy Mapping

Integration of provider ownership, enrollment and cost report data to create hospital profiles

CMS Data Integration

CMS Standardized Codeset Bridging & Integration

OpenFDA, RxNorm, CMS codesets to standardize codes; Integration of CMS ASP payment limits

Cloud-based Dashboard Design & Deployment

Cloud-based Dashboard Design & Deployment

Design and deployment of the database on a cloud-based BI platform for ready access and analysis