Smarter Tiering. Richer Data. Broader Coverage.

At Deerhold, innovation moves quickly. With the PRIZM platform, powered by Deerhold, there’s no traditional 6–12-month roadmap—our three-week sprint cycle ensures that client feedback and market needs are rapidly translated into meaningful platform enhancements.

PRIZM Version 5.0, alongside the May 2026 data refresh, delivers powerful new capabilities for brokers, stop-loss carriers, MGUs, TPAs, and healthcare providers—introducing tiered network analysis, expanding payer coverage to 44 carriers, and capturing new data fields from the Transparency in Coverage (TiC) Schema Version 2.0.

Product Enhancements

PRIZM Version 5.0 introduces a new Tier Comparison Report, PDF and PowerPoint export functionality across six report areas, new drill-down pathways, and expanded filtering and aggregation capabilities in PRIZM Rates.

New Tier Comparison Report

Self-funded employers and their advisors are increasingly evaluating multi-tier network designs—steering members toward preferred providers while preserving broad access. The new Tier Comparison Report brings this analysis directly into PRIZM.

• Users assign selected provider TINs to Tier 1 and Tier 2 and compare % of Medicare and % discount results against all remaining provider TINs—across multiple networks simultaneously.

• The Tier Analysis tab provides a tier-level breakdown of % of Medicare, enabling comparison of the same tier across networks.

• The % Medicare tab displays the overall network % of Medicare after applying tier-level weighting within each network.

What this means for Deerhold clients:

• More informed evaluation of tiered and steered network strategies

• Greater visibility into the financial impact of provider tier placement decisions

• Consistent comparison of tier performance across competing carrier networks

• Enhanced confidence in tier-based network recommendations

PDF and PowerPoint Export Functionality Across Reports

Export functionality has been extended to six report areas: Market Overview (Network and Hospital Comparison tabs), Hospital Comparison (Hospital Comparison and Contracting Approach tables), Key Drivers, Provider Disruption, Specialty Reports, and Network Adequacy.

What this means for Deerhold clients:

• Move directly from analysis to client-ready presentation materials

• Document methodology and results in a consistent, shareable format

New Drill-Down Pathways

• Hospital Comparison to Rates: Users can drill down from the Contracting Approach tab of the Hospital Comparison directly to the Rates page, with all filters carried through automatically.

• Auto-run Key Drivers: The Key Drivers report now runs automatically on drill-down, eliminating an extra step in root-cause analysis.

What this means for Deerhold clients:

• Trace a summary-level finding down to the individual rate records behind it

• Show your work—not just the answer—in client and underwriting conversations

Expanded PRIZM Rates Capabilities

• New TiC Schema Version 2.0 fields: Severity of Illness, Setting, and Billing Code Type Version are now available in Rates filters, fields, and Data Aggregation “Group By” options.

• 3-digit ZIP aggregation: The 3-digit ZIP code has been added to the “Group By” field in Data Aggregation, aligning rate analysis with the geographic granularity used in underwriting.

• Average % Medicare metric: A new Average % Medicare option in the Metrics dropdown, calculated as the total sum of Medicare percentages divided by the total record count. (Note: this is best applied when aggregating records spanning multiple codes, modifiers, or geographies).

• Copy-paste billing code selection: A list of billing codes can now be pasted directly into the billing code dropdown—no file build or upload required.

What this means for Deerhold clients:

• Faster, more flexible queries against the industry’s most current contracted-rate data

• Enhanced insight into inpatient reimbursement dynamics through severity-and setting-aware analysis

• Geographic benchmarking aligned with stop-loss and underwriting workflows

Usability Enhancements

• Hospital Rating/Quality have been added to Hospital Comparison and the Market Overview – Hospital report

• Column filtering by Type of Service and Metric in the Network Comparison Metrics Report

• Taxonomy aggregation now displays both code and description

• NULL original billing code modifiers can now be filtered

• Required fields are clearly marked in the Network Adequacy report

• Default inpatient weighting adjusted in Network Comparison

May 2026 Data Enhancements

The May 2026 refresh includes Transparency in Coverage machine-readable files (MRFs) produced by 44 carriers, including four new payer implementations—continuing Deerhold’s monthly refresh cadence.

Four New Payer Implementations

• Dean Health Plan

• Providence Health Plan

• Geisinger

• Point32 (including Harvard Pilgrim Health Care (HPHC))

What this means for Deerhold clients:

• Expanded regional coverage in the Upper Midwest, Pacific Northwest, Pennsylvania, and New England

• More complete network comparisons in markets where these payers compete

New TiC Schema V2.0 Fields Captured

To support payers adopting the TiC Schema V2.0, PRIZM now captures and surfaces three new fields: Severity of Illness, Setting, and Billing Code Type Version. These fields flow directly into PRIZM Rates filtering and aggregation.

What this means for Deerhold clients:

• Earlier access to the richer detail payers are beginning to publish

• More precise differentiation of inpatient versus outpatient contracted rates

Recalibrated Provider Weighting

All provider weighting has been recalibrated to incorporate weighting of critical care and cancer hospitals, improving the representativeness of network-level results where high-acuity facilities drive a meaningful share of spend.

What this means for Deerhold clients:

• Network comparisons that better reflect where high-cost care is actually delivered

• More credible results for stop-loss and high-claimant analysis

Expanded Data Capture and Provider TIN Standardization

• Standardization of TIN values for certain UHC records listed as “See Memo” in the source data

• Improved handling of null TIN and NPI source records

• Improved TIN assignment for records where PRIZM creates an inpatient Medicare rate record for per diem room-and-board revenue code arrangements

What this means for Deerhold clients:

• More usable rate records recovered from imperfect source files

• Cleaner provider-level rollups and network disruption analysis

Carrier and Network Updates

To ensure alignment with how health plan networks are recognized in the market, several naming updates have been implemented. Oscar Health network names have been standardized by removing the “Network” suffix, and BCBS MA file and network selection has been updated to use only Self-Insured files, with the “Self-Insured” suffix removed from selected network names for clarity.

What this means for Deerhold clients:

• Improved network identification and searchability

• Network naming that more closely reflects real-world market and carrier conventions

Why This Release Matters

PRIZM Version 5.0 reinforces Deerhold’s leadership in healthcare price transparency by pairing rapid product innovation with continually expanding data depth. As employers and advisors move toward tiered and steered network designs, PRIZM is the first place those strategies can be modeled against current contracted rates—not stale historical claims.

Key Advantages for Prospective Clients

• Rapid innovation: Enhancements delivered through a three-week sprint cycle

• Tiered network modeling: TIN-level tier assignment with % of Medicare results across competing networks

• Comprehensive coverage: 44 carriers, refreshed monthly

• Forward-compatible data: Early capture of TiC Schema Version 2.0 fields as payers adopt them

• Presentation-ready output: PDF and PowerPoint export across six report areas