Since 2022, federal price transparency rules have required health insurers to publish their negotiated hospital rates, aiming to give providers, employers and patients greater visibility into healthcare costs. However, the resulting machine-readable files are often so large and inconsistent that most organizations struggle to use them effectively.
A single payer's pricing file can contain billions of rows, often published in varying formats and riddled with errors. According to a recent provider survey, nearly 40% of organizations report limited or no meaningful use of Transparency in Coverage data when preparing for payer negotiations.
Startup Payerset launched four years ago to tackle this challenge, building the infrastructure required to normalize the data and render it usable across the formats healthcare organizations rely on.
The company launched an artificial intelligence-powered, self-service research assistant that unifies negotiated rate data, claims, policy and market benchmarking into one platform. Payerset's platform draws on 20 trillion rate records retained since 2024 with more than 10 trillion more processed every quarter, according to the company.
Using the research assistant tool, health systems can ask plain-English questions about their market position and get instant, data-backed answers, executives say.
"It's like having extra researchers on your team," Jerry DiMaso, Payerset co-founder and CEO, told Fierce Healthcare.
Hospitals and health systems can use the AI research tool to get the most current view of the market and a full, longitudinal record of how rates have shifted over time, along with plain-language answers, without needing an analyst, a data team, or specialized training, according to the company.
Providers are using healthcare pricing transparency data primarily to strengthen contract negotiations by comparing their reimbursement rates against competitors, DiMaso said. The transparency data is also giving employers and benefits brokers new visibility into healthcare pricing, allowing them to assess whether their health plans are getting competitive rates and, in some cases, independently reprice claims rather than relying solely on insurers, he noted.
What began as a tool for contract negotiations and rate benchmarking has evolved into a broader market intelligence platform that helps health systems analyze reimbursement trends, compare contract structures and identify payer behaviors. By combining pricing and claims data with AI-powered analysis, healthcare organizations can investigate complex issues, such as downcoding patterns and reimbursement disparities, in ways that were not possible a few years ago, DiMaso said.
The research assistant tool builds on Payerset’s existing products: Rate Explorer, which lets managed care and finance teams compare negotiated rates directly, and Data Lake, which gives health tech companies and consultants API access to that same data, according to the company.
The company also offers a free employer benchmark tool that enables companies to search more than 129,000 self-funded employers and compare any plan's negotiated rates with other carriers and Medicare.
Payerset plans to launch a consumer-facing AI tool that lets patients upload hospital bills to verify whether claims were processed correctly and whether they were charged the appropriate negotiated or discounted cash rate.
Research Assistant is available in two forms. A Model Context Protocol (MCP) server lets healthcare organizations plug Payerset's pricing, claims and policy data directly into the enterprise AI tools they already use, including Claude and ChatGPT, without needing a separate interface. A companion portal product embeds that same intelligence in a chat-style experience within Payerset's own platform, for teams that want direct, conversational access without their own AI integration.
In both formats, users can move beyond raw market data and ask direct, strategic questions, instantly receiving a data-backed answer, whether that's how their negotiated rates compare to peer health systems in their market, which states offer the strongest reimbursement for a given service line, or where a fee schedule gap is costing them revenue before they ever sit down at the negotiating table, executives said.
Price transparency regulations have pushed hospitals and health insurance companies to publicly disclose their pricing data to eliminate hidden medical costs. But turning that data into actionable intelligence has been a challenge. DiMaso and Jacob Little, both former healthcare consultants, founded Payerset in 2022 to help hospitals, health systems, consulting firms, health tech vendors and other organizations make sense of healthcare pricing data.
"When the Transparency in Coverage regulations came out, that was a huge data problem: every single provider, tens of thousands of billing codes, custom contracts, carve-outs, all these types of very complex things with healthcare pricing. They had to codify that into a dataset. It's trillions of rows of data strewn all over the internet. It's a very complex web of how healthcare pricing and networks actually work," DiMaso said.
Payerset says it collects every Transparency in Coverage and hospital price file published since 2022, filters out the ghost rates, links them to claims and remits and makes the result readable.
Jiro Health, a practice intelligence platform for clinicians and physician-led practices, integrated Payerset’s normalized pricing and claims intelligence directly into its platform. That market intelligence gives clinicians and practices actionable insights for a range of financial and strategic decisions, including reimbursement benchmarking, RVU calculation, denial remediation, contract negotiations and growth planning, according to Jiro Health.
"Health systems have struggled to get real market visibility into this kind of data, and for individual clinicians and small practices, it has been even further out of reach," Greg Field, founder and CEO of Jiro Health, said in a statement. "With our partnership with Payerset, we can now deliver actionable financial intelligence for individual clinicians they can’t see anywhere else."
Payerset currently has 31 unique customers and nine hospital and health system customers, including Northwell Health, WakeMed, Prisma Heath and Cone Health.
The four-year old company was bootstrapped from the start and avoided costly big-data platforms by building its own purpose-built data infrastructure, DiMaso said. The company developed custom technology optimized for healthcare pricing files, allowing it to process massive transparency datasets more cost-effectively while still capturing the full breadth of the data.
"We bootstrapped to profitability," he said. "We took a small amount of debt last year to hire more people. That has been already repaid. We've been a profitable business since we started, and it's forced us to make technology decisions. It just made us very efficient with the way that we process data and serve it to users, and that's ultimately, I think, helped us get an edge competitively as well."
The Trump administration has signaled that it plans to ramp up enforcement of price transparency requirements. In June, there were media reports that more than 500 hospitals falling short on price transparency requirements received warnings from the federal government since April, with more “likely” to receive similar notices soon. A report from the AP cited an unnamed “senior administration official” who shared a list of 519 nationwide hospitals that recently received either a warning notice or a Corrective Action Plan (CAP) request.
As the Centers for Medicare and Medicaid Service (CMS) puts a stronger focus on price transparency, compliance among health systems and insurers has increased, DiMaso noted. Employers also are becoming more interested in accessing and using price transparency data.
"We are getting much closer to having full transparency, and ultimately, I think people have started to recognize that the more transparency we have, the less regulation we have to have. So, we can deregulate through transparency, and we can reduce a lot of administrative burden and reduce a lot of costs for the carriers, for the providers, if there's more transparency," DiMaso said.