MultiPlan : Fact Sheet

June 2024

Background on MultiPlan

The complexity of the U.S. healthcare system has contributed to rising costs and patients struggling to afford the care they need. MultiPlan helps patients, as well as employers who provide healthcare benefits, navigate this complexity by making healthcare more transparent, fair, and affordable for all and lowering costs for patients and employers.

MultiPlan At a Glance

as of 2023 Fiscal Year End

40+		~2,800		14			$961.5M	$168.6B
YEARS IN		EMPLOYEES		OFFICE			REVENUE IN	MEDICAL CLAIM
BUSINESS					LOCATIONS			2023		CHARGES
										PROCESSED
Who We Serve
700+			Who	100k+	Who	60M			Who
insurance carriers, plan	employers /	plan members and
Serve	Cover		Access
administrators, and		plan sponsors	patients with access
other payor customers						to our services

$22.9B

IDENTIFIED

POTENTIAL COST

SAVINGS

1.4M

contracted healthcare providers

MultiPlan plays a vital role in helping to reduce healthcare costs across the entire healthcare ecosystem, making care more affordable for patients across America.

• Using our out-of-network pricing services, MultiPlan processed $25.7B in charges and identified $14.3B in savings in 2023, ultimately saving payors, health plans, and patients over $900 on average per claim, translating to over 55% savings on the average bill.
• Without MultiPlan, many patients would not be able to obtain affordable out-of-network care and instead would face exorbitant medical bills for healthcare services.
• MultiPlan delivers on the promise of price transparency through PlanOptix, which transforms publicly-available CMS data into usable and actionable insights for brokers, payors, and employers.

MultiPlan makes healthcare more efficient by helping payors and providers establish a fair payment for healthcare services, including when a patient chooses to go to an out-of-network provider.

• MultiPlan's objective and always data-driven approach enables provider claims to be processed quickly and fairly and helps avoid provider overbilling.
• Of the 15.4M out-of-network claims that MultiPlan helped price in
  2023, providers accepted MultiPlan's recommended price 98% of the time without an initial appeal, demonstrating our ability to efficiently recommend a fair payment level. We subsequently improve our acceptance rate by negotiating with providers that appeal.

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Since our founding over 40 years ago, MultiPlan's data-driven services continue to minimize or eliminate balance bills for patients, completely in alignment with the No Surprises Act.

• On January 1, 2022, the No Surprises Act went into effect, prohibiting providers from balance billing patients for surprise charges, ensuring patients are only responsible for in-networkcost-sharing amounts for certain services, and establishing a resolution process for any provider-payor disputes.
• In response to the No Surprises Act, MultiPlan invested significantly in a new service offering to support compliance with the legislation.
• In 2023, MultiPlan's services and repricing recommendations helped eliminate approximately 10.5M balance bills for patients, which we believe is as large as the volume that the patient-friendly No Surprises Act eliminated in the same period.
• MultiPlan meets the needs of patients impacted by medical bills, and we stand with policymakers working to make healthcare more affordable.

© 2024 MultiPlan Corporation

Facts About Our Services

Fees

Tool

Methodologies:

Data iSight

• MultiPlan is not an insurer, does not make coverage decisions, and does not issue balance bills.
• In 2023, the average initial charge for out-of-network facility claims processed was 741% of Medicare. To help address that, MultiPlan helps payors and providers by recommending a fair payment for healthcare services.
• MultiPlan's offerings reduce the medical cost burden across the healthcare ecosystem and deliver value to patients. We build and manage custom healthcare provider networks, recommend fair reimbursements based on public data for out-of-network claims, help identify, correct, and prevent improper billing, and deliver actionable, digestible data to drive plan design and lower healthcare costs.
• Our analytic solutions are enabled by publicly available third-party data, including Centers for Medicare & Medicaid Services (CMS) data.
• In 2023, MultiPlan had approximately 98% initial acceptance of the claims we priced, defined as contractually accepted or not initially appealed. MultiPlan helped eliminate more than 10.5M balance bills for patients, which we believe is as large as the volume that the patient-friendly No Surprises Act eliminated in the same period.
• For professional claims, the payment recommendation is generally based on the median amount reimbursed by commercial payors for the same services in the same geography using publicly available nationally-recognized components and national comparison data. If the outputs of these methodologies result in a significant discount off the charges billed, it may indicate that the charges billed are excessive.
• Applying national benchmarking, regional wage indexing, and geographic adjustment, among other methods, allows for a fair reimbursement compared to Usual and Customary and Medicare-Based pricing.
• In 2023, we processed over $25.7 billion in out-of-network charges.
• MultiPlan offers a number of different pricing models which serve the different business models of our customers, including a flat per-member-per-month fee pricing model. The flexibility provided by our different pricing models helps to meet the diverse objectives of our customers and the health plan sponsors that our customers support.
• In many cases, a percentage of savings model better aligns MultiPlan with our clients, self- funded employer plan sponsors and plan members, toward our shared goal of containing the all- in cost of healthcare.
• For percentage of saving services, our fee is calculated using the amount of savings we identify on behalf of our clients. The savings generated ultimately benefit employees and their family members through their plan sponsors, who are typically self-funded employers, by reducing direct medical costs, mitigating the growth of health insurance premiums, and reducing balance bills.
• MultiPlan's overall fees as a percentage of savings for pricing OON claims are in the aggregate approximately 5%. In 2023, the average revenue per claim on 15.4M out of network claims was $44 per claim.
• Launched in 2007, the Data iSight methodology was developed out of a need to have a cost- based, rather than charge-based, approach to reimbursement that was transparent, fair, and rewarded efficient providers.
• Data iSight is patented and validated by statisticians as effective and fair all while delivering savings on non-contracted claims with broad provider acceptance.
• Data iSight recommends a reimbursement based on the median cost of a benchmark group of like facility claims (e.g., similar type and size of facility, same severity level of the patient, same geographic area) using cost data hospitals submit to CMS and a margin factor that rewards efficient facilities.

2	© 2024 MultiPlan Corporation