Free where it’s a public good, paid where the savings are.
Much of the network is free — permanently, for everyone. Two simple utility fees fund it all: a flat per-member-per-month participation fee for payers, and one fee for providers on aggregate routed paid-claim volume. Nothing is priced per transaction, no capability is priced separately, and everything patients touch is free. Rates are governed by an independent Council under a lowest-sustainable-fee mandate, with fee-payers recused from decisions on their own rates.
What’s free — the Open Access tier
Start with what costs nothing, because most of the network’s daily use won’t carry a fee. The Open Access tier is permanent and free for everyone, by operation, never metered: patient access, eligibility, public-health reporting, participant onboarding, and baseline conformance testing. Prior authorization is also free to use — funded by the utility fees below, and we say so openly. Free where it’s a public good, paid where the savings are: the paid layer exists to fund the free one, and surplus is reinvested, not extracted. (Certified Network Partner certification is a separate program and buys no routing rights or priority.)
The rates
Every fee-paying participant is on one of two tracks. Standard pricing applies from a participant’s first day on the network, whenever it joins. Launch Participant pricing is the discounted multi-year track for those who sign by December 31, 2026 — signing, not deploying; your go-live is assigned by cohort. On January 1, 2030, the two tracks converge: every participant is on the standard rate named in its own agreement.
| Participant / tier | Track | Rate |
|---|---|---|
| Open Access | Free — permanently, for everyone | Free: patient access · eligibility · public-health reporting · onboarding · conformance testing |
| Patients | Free, always | Free |
| Payers | Launch Participant (sign by Dec 31, 2026) | $0.25 PMPM through 2029 (sign by Dec 31, 2026; certify by Dec 31, 2027 per market), then standard |
| Standard (everyone else, from day one; everyone from Jan 1, 2030) | $0.50 PMPM | |
| Providers | Launch Participant (sign by Dec 31, 2026) | $0 through 2028 · 0.025% in 2029, then standard |
| Standard (everyone else, from day one; everyone from Jan 1, 2030) | 0.05% of aggregate routed paid-claim volume |
Standard: $0.50 PMPM.
Standard: 0.05% of aggregate routed paid-claim volume.
No charge to the patient, no network usage fee for patient-authorized access — ever.
Unlimited volume, every transaction type in the catalog. Launch Participants who sign in 2026 pay $0.25 through 2029 in each market production-certified by December 31, 2027, stepping to $0.50 on January 1, 2030.
The rate lock isn’t a prior-authorization discount — it’s the price of the full network. Launch Participant terms follow the published calendar: as each new release ships — claims and remittance arrive in April 2027 — your gateway already has the rails, and activation in your market follows within a 90-day window. If a release date moves, the window moves with it. Nothing to re-buy, nothing to re-integrate: one signature, one calendar, every transaction in the catalog.
Metered at your own gateway. No individual claim carries a charge; prior authorization and eligibility are never metered for pricing. Launch Participants — committing to prior authorization by January 2027 and claims migration by January 1, 2028 — pay nothing on routed claims through 2028, 0.025% in 2029, and the published 0.05% from January 1, 2030.
Full participation means routing your transactions through your gateway as each release goes live — including claims and remittance in April 2027, when the largest savings begin. Your fee holiday runs through 2028 regardless; connecting early to each release costs nothing and starts the savings sooner.
This is not a share of reimbursement and not a fee on individual claims. Routed paid-claim volume is the auditable usage proxy, measured at the provider’s own gateway; SHN does not hold funds, take assignment, or price on clinical content.
Why the prices are small against what they replace
The avoidable administrative waste the network attacks traces to a single defect: at the moment of a transaction, nobody is sure the information is right. Because no one is sure, everyone re-asks — by phone, fax, portal, and letter — and because the answers are still often wrong, everyone pays again downstream: denials, rework, write-offs, recoveries, bad debt. A transaction through the hub is right at the source, once. The work of asking shrinks, and the cost of being wrong shrinks. The utility fees are set against each organization’s own share of that waste: at typical volumes, the fee is a small fraction of the administrative cost the network removes. Each stakeholder page carries the numbers.
The savings ladder — what the fee buys back
| Hard-dollar replacement alone | + time returned & compliance avoided | + measured downstream savings | |
|---|---|---|---|
| Providers | ~11x the fee (physician group) · ~8x (health system) | ~15x · ~14x | ~20x blended |
| Payers | ~6x the fee | ~8x | ~10x |
| States | ~14x the fee | — | ~24x (incl. third-party-liability recovery) |
How these numbers are built. The model follows four rules. First, the fee must clear on bankable replacement alone — benchmark-sourced hard dollars (CAQH Index per-transaction costs, AMA prior-authorization burden data) for work that stops existing; everything above that layer is compounding, not justification. Second, moved money is never counted as saved money — a dollar that shifts from one party to another is counted once, as a transfer, never presented as system savings. Third, every return is net of the cost to achieve it — onboarding, integration, and change management are in the denominator. Fourth, outcomes are measured, not asserted: Delaware’s launch measures the outcome layers in production, every participant sees its own computed fee alongside the cost it displaces on a monthly network statement, and the 2030 standard rate arrives with that evidence on the table.
Directional modeled estimates from industry benchmarks (CAQH Index, AMA survey data) at typical volumes; each participant sees its own results on its monthly network statement.
How the rates stay honest
Launch Participant rates lock at signature and hold through 2029. From January 1, 2030, every participant steps to the standard rate named in its own agreement — and rates are governed by the independent Council under its lowest-sustainable-fee mandate. The structure removes the incentive to do otherwise: Smart Health Network PBC operates under a public-benefit duty, investor returns are capped, and surplus is reinvested in the network, not extracted.
The Launch Participant window
Launch Participant pricing goes to organizations that sign in 2026 — the window closes December 31, 2026, and the rate locks at signature. When you go live depends on when you commit: commit by September 30, 2026 (a short-form commitment reserves your seat; January-cohort agreements execute by November 30, before December production burn-in — the supervised live run in which real transactions route on production credentials before go-live) and you launch with the January cohort. Sign later in 2026 and you keep Launch Participant pricing — you simply launch with your market’s next cohort, as claims, pharmacy, and quality follow on the published calendar. One window for the price; quarterly cohorts for the go-live. After December 31, 2026, the published standard rates apply. A seat in a cohort is a reservation — and reservations are how the network never launches empty. Questions about Launch Participant terms →
One connection. Two simple utility fees. Every transaction in the governed catalog — on a published calendar, with a seat you can reserve. See the catalog & roadmap →
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.