Use Case Examples

How Providers & IDR Professionals Can Use FlexPoint Data:

FlexPoint data is equally deployable for providers, IDR counsel, and IDR management firms building the case for fair reimbursement. The examples below illustrate specific applications across each audience.

① Contract Renewal Rate Justification
Revenue Cycle / Payer Contracting
The Situation
A provider group is entering contract renewal negotiations with a national insurer. The insurer's network team arrives with self-reported benchmarks and selective MRF data to support its position. The insurer is offering a flat renewal or minimal increase, asserting that the provider group's current contracted rates are already at or above prevailing market levels.
How FlexPoint Helps
FlexPoint recruits patients treated by comparable providers in the same specialty and market, and procures their EOBs — extracting the exact contractual rates paid by this same insurer for the same codes, specific to insurer product, Tax ID/NPI, and current dates of service.
Outcome for the Provider
The provider group's negotiators arrive with irrefutable EOB evidence of what the insurer actually pays comparable providers for the same services in the same market. The insurer's lowball framing is neutralized with objective data. When EOBs confirm that comparable providers in the same market are already reimbursed at higher rates, the insurer's position collapses. FlexPoint eliminates the information asymmetry payers rely on to justify below-market offers.
② No Surprises Act / IDR Arbitration
Legal / IDR Operations
The Situation
An out-of-network EM group has filed an IDR claim against a national insurer. The arbitrator must weigh the insurer's QPA against additional credible market rate evidence. A provider relying on inaccurate MRFs, self-reported benchmarks, or its own billed charges is at a structural disadvantage.
How FlexPoint Helps
FlexPoint recruits patients treated by comparable EM providers in the same market, and procures their EOBs — extracting the exact rates this same insurer is currently paying for the same codes. These EOB documents are certified and submittable directly as IDR exhibits, not just summaries or reports, and are more current, more specific, and more verifiable than anything the insurer can otherwise present. Arbitrators are required to weigh the QPA against credible market data. There is no more credible market data than an EOB.
Outcome for the Provider
The EM group submits irrefutable evidence of what the insurer actually pays comparable providers for the same services in the same market. When evidence is more current, more specific, and more verifiable than the insurer's own QPA methodology, the arbitrator takes notice. FlexPoint clients enter IDR with a structural advantage.
③ Large National Staffing Company Pre-Negotiation
Revenue Cycle / National Accounts
The Situation
A large national physician staffing company — operating across Emergency Medicine, Anesthesiology, and Hospital Medicine — is preparing for a high-stakes contract renegotiation with a national insurer. These specialties carry high OON exposure and active IDR filing histories. The insurer will arrive with aggressive multi-market rate decrease demands and a sophisticated legal and data team of its own. The staffing company needs to be equally prepared.
How FlexPoint Helps
FlexPoint begins systematic EOB collection 6 months in advance of the renewal across the staffing company's key markets — recruiting patients treated by comparable providers in the same markets and specialties, and extracting the exact rates this same insurer is currently paying them, specific to insurer product (PPO vs. HMO), specialty, Tax ID/NPI, and date of service. FlexPoint has deep expertise in Emergency Medicine, Anesthesiology, and Hospital Medicine — the exact specialties at issue. Data is organized market by market, specialty by specialty, giving the staffing company's team granular rate intelligence at every table where the insurer will push for cuts.
Outcome for the Provider
The staffing company enters the renegotiation with the most current, granular, and defensible market rate intelligence available — specialty by specialty, market by market, insurer product by insurer product. Every rate decrease demand can be countered with actual EOB evidence showing what this same insurer already pays comparable providers. Without this data, the staffing company negotiates blind against a well-prepared counterparty. FlexPoint data is equally powerful if disputes proceed to IDR arbitration post-renewal.
④ MRF Validation
Revenue Cycle / Contract Analytics
The Situation
Machine-Readable Files are often incomplete, outdated, or don't reflect what's actually being paid. A provider needs to validate the accuracy of a hospital's and/or payer's MRF data.
How FlexPoint Helps
FlexPoint validates the accuracy of MRFs and other market rate datasets by comparing published rates against actual allowed amounts derived from patient EOB documents — a discrepancy detection capability unavailable through any other methodology. When published rate data is inaccurate, incomplete, or unavailable, EOBs fill the gap entirely.
Outcome for the Provider
Accurate, defensible MRF comparison data. Without EOB data, competitive intelligence gaps are inevitable. FlexPoint eliminates that risk — delivering verified, defensible MRF comparison data that keeps the provider's view of the rate landscape complete and current.
⑤ Narrow Network Design for Employer Contracting
Growth Strategy / Network Design
The Situation
A hospital or provider group is designing a narrow network product to contract directly with a large self-funded employer. The hospital / provider group needs to price its services competitively against what the employer's current network providers are being paid — without giving away more margin than necessary to win the deal.
How FlexPoint Helps
FlexPoint recruits patients who are employees of the target employer (or covered dependents on the employer's plan) and procures their EOBs — identifying the exact rates the employer's current network providers are being paid, by specialty, product type, and procedure code.
Outcome for the Provider
The hospital / provider group enters employer contract negotiations knowing exactly what the employer is currently paying its network providers — able to price the narrow network competitively while protecting margin, rather than guessing at what the employer will accept. FlexPoint arms the team with the market intelligence needed to negotiate from a position of strength.
⑥ M&A / Due Diligence
Corporate Development / Actuarial
The Situation
A physician group (or private equity-backed platform) is evaluating the acquisition of another multi-specialty physician group operating across several markets. Before finalizing deal terms, the acquiring team needs to understand what payers are actually paying the target group across its key specialties — information that is rarely disclosed accurately in the target's own financial representations.
How FlexPoint Helps
FlexPoint recruits patients treated by the target physician group and procures their EOBs — extracting the exact contractual rates paid by Aetna, BCBS, Cigna, UHC, and other payers across the group's specialties, markets, and insurer product types. Because EOBs are sourced directly from patients, the data cannot be manipulated or selectively presented by the acquisition target. FlexPoint delivers 100% verified allowed amounts, specific to Tax ID/NPI, insurer product, place of service, procedure code, and date of service.
Outcome for the Provider
The acquiring team avoids surprises in contracted rate structures. The data directly informs deal pricing, integration planning, and post-close renegotiation strategy — rather than relying on the target's self-reported numbers, which have an obvious incentive to overstate reimbursement ahead of a sale.