New AI-enabled innovation translates complex government-required public transparency data into a flexible, market-informed, and explainable methodology for evaluating reimbursement strategies.
MCLEAN, Va., Oct. 29, 2026 (GLOBE NEWSWIRE) — Claritev Corporation (“Claritev” or the “Company”) (NYSE: CTEV), a healthcare technology, data, and insights company, today announced the launch of Transparency-Based Pricing, a new market-informed reimbursement intelligence solution designed to give payers and third-party administrators (TPAs) greater flexibility and confidence as they manage healthcare costs and reimbursement strategies. The solution translates government-required public transparency data into market inputs and supporting rationale that clients can use within their own individualized reimbursement approaches.
Healthcare costs remain one of the most consequential pressures facing payers, employers, and the people they serve. Organizations need reimbursement approaches that can accommodate different claims, service categories, geographies, plan designs, and client objectives, while providing reimbursement rationales they can understand, explain, and support.
Announced at Claritev’s annual Client Conference, Transparency-Based Pricing gives clients an additional market-informed methodology to evaluate alongside their existing reimbursement strategies. It is designed to make government-required public transparency data accessible and operational for each client in their day-to-day reimbursement decisions, rather than simply making more data available.
Federal transparency requirements have made substantial volumes of in-network negotiated-rates and out-of-network reimbursement data publicly available, creating a powerful new source of market information, but one that is difficult for most organizations to use effectively or at scale. Claritev is putting that government-required public transparency data to practical use, applying responsible, AI-enabled processes to ingest, clean, normalize, and standardize more than 1.7 trillion machine-readable file records. The Company then applies more than four decades of healthcare expertise to identify relevant market inputs, such as publicly available rates for comparable services, providers, and geographies, and generate reimbursement reference points from that public data that each client can evaluate for their individual claims.
Transparency-Based Pricing does more than put transparency data or rate benchmarks at a user’s fingertips. It provides source-traceable public market inputs, claim-level reimbursement reference points, and supporting rationales that can be applied through established claims workflows. Each client independently evaluates that information and determines the reimbursement amount for each claim under their own policies and business rules.
“Payers and TPAs are under real pressure to make reimbursement decisions that are consistent, well-supported, and workable across a wide range of client needs. But having access to vast troves of public pricing data is not the same as making sense of it,” said Sean Crandell, Senior Vice President and General Manager, Claims Intelligence, at Claritev. “Transparency-Based Pricing gives teams a clearer, more practical view of the market and a source-traceable reference point they can evaluate under their own reimbursement policies, without having to build and maintain an enormous data infrastructure themselves.”
Transparency-Based Pricing expands, rather than replaces, the reimbursement options available to Claritev clients. Each client can configure it alongside established approaches, including negotiated rates, Medicare-based methodologies, and other reference points, to support a particular claim, service category, geography, client strategy, or business objective. Claritev expects to make the methodology available across multiple cost-containment applications over time, expanding the ways employers can use market-informed reimbursement intelligence within their established operations.
Key capabilities include:
- Putting transparency data to practical use: Converts complex, government-required public transparency data into standardized market inputs and source-traceable reimbursement reference points that clients can evaluate under their own reimbursement policies.
- Supporting more informed reimbursement strategies: Gives payers and TPAs an additional market-informed reference point to evaluate as they manage reimbursement variation, medical cost trends, and varied plan requirements.
- Providing explainable, supportable rationale: Delivers source-traceable public market inputs, repeatable outputs, and clear reimbursement rationale to support internal review and communications with clients and providers.
- Bringing innovation into existing workflows: Makes sophisticated public data standardization and reimbursement intelligence available through established claims workflows, without requiring organizations to build and maintain their own transparency-data infrastructure.
Transparency-Based Pricing is part of Claritev’s broader Claims Intelligence portfolio, which helps clients manage healthcare costs and navigate the complexity of reimbursement through technology, data, and market expertise. The solution reflects Claritev’s approach to responsible AI: applying advanced technology to practical healthcare challenges while keeping explainability, traceability, human expertise, and individual client decision-making at the center.
About Claritev
Claritev is a healthcare technology, data, and insights company focused on delivering affordability, transparency, and quality across the U.S. healthcare system. Led by deeply experienced associates, data scientists, and innovators, Claritev provides technology-enabled solutions fueled by decades of claims expertise. The company leverages advanced analytics and AI to power a robust enterprise platform that delivers clear, actionable insights to support affordability, price transparency, and optimized network and benefits design. By supporting key stakeholders, including payers, employers, patients, providers, and third parties, Claritev is dedicated to making healthcare more accessible and affordable for all.
Claritev serves more than 750 healthcare payers, over 100,000 employers, 60 million consumers, and 1.4 million contracted providers. For more information, visit claritev.com.
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