Abstract: Embodiments of methods and systems for predicting provider negotiated rates are disclosed. One method includes obtaining claims data and provider data, grouping the claims data into priceable units, computing prices for each of the priceable units based on the claims data and the provider data, and estimating provider negotiated rates based on the priceable units and the computed prices for the priceable units.

Abstract: Embodiments of methods and systems for predicting provider negotiated rates are disclosed. One method includes obtaining claims data and provider data, grouping the claims data into priceable units, computing prices for each of the priceable units based on the claims data and the provider data, and estimating provider negotiated rates based on the priceable units and the computed prices for the priceable units.

Abstract: Embodiments of computer-methods and computer systems for predicting out-of-pocket expense for a patient are disclosed. One computer-method includes obtaining claims data and provider data and grouping the claims data into priceable units. A server computes prices for each of the priceable units based on the claims data and the provider data. The priceable units are collected into bundled services as required for predicting the out-of-pocket expense of an episode. Attributes of a health plan of the patient are applied, and an out-of-pocket calculator predicts the out-of-pocket expense based on the collected priceable units and the computed prices for the collected priceable units. The out-of-pocket expense is communicated to patient through a network.