Get paid faster, with less paperwork.
The connection.
One connection replaces per-payer portals, faxes, and bilateral integrations: prior authorization and eligibility from day one, claims and remittance as they go live in your market, and each new catalog category after them — all on the same connection. Full participation means moving claims and remittance onto network routes as they arrive.
Prior authorization is the on-ramp. Claims is the destination. Connect once for January, and your gateway is already ready when claims and remittance arrive in April 2027 — when the biggest savings begin.
The price.
One fee — 0.05% of aggregate routed paid-claim volume, metered at your own gateway. No individual claim carries a charge, and nothing else — prior authorization, eligibility, new categories — is metered for pricing. Routed volume is simply the cleanest proxy for the administrative work the network replaces.
What it replaces.
The lines your CFO already budgets: eligibility-verification labor, prior-authorization staffing and follow-up (roughly 13 hours per physician-week of combined physician and staff time), status-check calls, remittance posting and reconciliation, clearinghouse fees and RCM modules, and the rework that follows front-end denials. Hard dollars alone — work that stops existing — run roughly 11x the fee for a typical physician group and 8x for a health system. Clinician time returned to care and compliance builds avoided sit on top, taking it to roughly 15x and 14x. Measured downstream savings — denials that stop happening, faster payment, write-off protection at high acuity — take the blended total to roughly 20x across provider types.
Launch Participant terms.
Commit to prior authorization by January 2027 and claims migration at your market’s claims release — no later than January 1, 2028. Pay nothing through 2028, a 0.025% transition rate in 2029, and the published 0.05% from January 1, 2030 — with a monthly statement throughout showing the computed fee alongside the cost it displaces. The window closes December 31, 2026.
Getting connected.
Your EHR and the systems you already run stay; a Smart Gateway at your edge (yours, or run by a certified partner) connects you. Onboarding and baseline conformance testing are free — part of the network’s Open Access tier — and in rural-health states, transformation funding can pay for the onboarding work. Start in the sandbox today; prove conformance at a Connectathon; the same green check is your go-live gate.
For most providers this should not be a custom IT project: certified partners — your EHR vendor, your state’s health information exchange, revenue-cycle firms — do the connection work using the systems you already run, and states are funding provider onboarding. Many practices will pay nothing to connect, and nothing to transact through 2028. Say yes to the invitation; the network does the rest.
Savings multiples are directional modeled estimates built on industry benchmark data, including the CAQH Index and AMA survey data, at typical volumes. Results vary by organization, starting cost, route migration, market density, and decommissioning timing; each participant sees its own results on its monthly network statement.