Compare More. Price More. See More.

PRIZM Version 5.1 is built around a simple idea: the more complete the picture, the better the decision. This release brings multi-network comparison to Provider Disruption, extends Medicare-equivalent repricing to previously unpriceable billing code types, and refreshes payer coverage to 43 carriers—all shipped through Deerhold's monthly sprint cycle.

Product Enhancements

PRIZM Version 5.1 introduces a new Upset Plot visualization for Provider Disruption, a map-based view of provider overlaps, expanded totals in Network Comparison Metrics, and TIN list upload support in Tier Comparison.

Provider Disruption – Upset Plot

Comparing more than two networks at once has historically meant stacking Venn diagrams that quickly become unreadable. The new Upset Plot view solves this directly inside Provider Disruption.

● Users can select more than one network or carrier for comparison; when more than one is selected, PRIZM automatically displays the Upset Plot in place of the Venn Diagram.

● The Intersection Size Chart shows the top 15 intersections by provider count, so the most meaningful overlaps surface first.

● The Set Size Bar Chart and Dot Matrix make it easy to see, at a glance, which networks participate in each intersection and how much overlap exists between any combination of them.

What this means for Deerhold clients:

● Clearer visualization of coverage gaps and overlaps across more than two networks

● Faster identification of the most significant intersections without manually cross-referencing multiple Venn diagrams

● A more scalable way to support multi-carrier network evaluations


Addition of Map Display Feature

Provider Disruption now offers a Map View alongside the existing Table View, so users can toggle between tabular detail and a geographic view of Home, Comparison, and shared-network providers.

What this means for Deerhold clients:

● Immediate visual context for where coverage gaps or overlaps are concentrated

● Easier communication of network disruption findings to non-technical stakeholders

Network Comparison Metrics Totals

● A new Total Geography metric provides weighted totals across all selected geographic filters, alongside individual geography results.

● Total Type of Service metrics (% Medicare, Discount, and Confidence) are now available in both Consolidated and Non-Consolidated views, using weighted calculations.

● Drill-down and CSV export are supported for the new total metrics, keeping them consistent with existing Network Comparison calculations.

What this means for Deerhold clients:

● A single, weighted summary view across geographies without losing the ability to drill into individual markets

● Consistent, exportable totals that fit directly into existing reporting workflows

Tier Comparison Uploads

● Users can now upload a TIN list to populate Network Tiers—a faster alternative to manual entry.

● Upload validation flags unsupported tiers (e.g., Tier 3 and Tier 4) and summarizes valid and invalid TINs, tier counts, and TINs per tier.

● PDF and PowerPoint export are now available for Tier Comparison results.

What this means for Deerhold clients:

● Significantly faster setup of tiered network analyses, especially for large provider lists

● Presentation-ready tier comparison output without leaving PRIZM

Hospital Comparison – Billing Code Weighting

Billing code weight and weight % have been added to the Contracting Approach table in Hospital Comparison.

What this means for Deerhold clients:

● Greater transparency into which billing codes are driving a hospital's contracted rate results

PRIZM Engine Logic Enhancements

Additional Medicare Repricing Support

APR-DRG and CSTM-ALL are billing code types that have historically been excluded from Network analysis because they lacked a reliable Medicare-equivalent rate. Recent CMS reporting requirements now make it possible for PRIZM to accurately interpret these records and calculate a Medicare-equivalent rate.

● APR-DRGs, used primarily by BCBS in markets including Massachusetts, Minnesota, Iowa, North Dakota, and South Dakota, are now supported with payer-specific severity-of-illness-based weighting.

● CSTM-ALL records, used most heavily by Cigna, can now be accurately classified by inpatient or outpatient setting, bringing Cigna outpatient rates more in line with other carriers and increasing overall confidence in the results.

What this means for Deerhold clients:

● Previously excluded billing code volume is now part of the Network analysis, improving completeness

● More accurate, more comparable % of Medicare results in markets where APR-DRG and CSTM-ALL contracting is common

Provider Weighting Refinements

Weighting adjustments specific to Long Term Care Hospitals and Children's Hospitals have been incorporated into the PRIZM engine.

What this means for Deerhold clients:

● Network comparisons that more accurately reflect the role of specialized facility types

Additional Medicare Payment Methodologies

Medicare payment methodologies for Long Term Care Hospitals (LTCH), Inpatient Rehab Facilities (IRF), and Inpatient Psychiatric Facilities (IPF) have been added to the PRIZM engine, with comparable Medicare weights now available in Rates.

What this means for Deerhold clients:

● Access to Medicare-comparable pricing for additional facility types directly in Rates

Why This Release Matters

PRIZM Version 5.1 reinforces Deerhold's commitment to pairing rapid product innovation with increasingly complete and accurate data. As CMS reporting requirements evolve and payers report an ever-wider range of billing code types, PRIZM continues to extend Medicare-equivalent repricing to data that was previously unusable—giving brokers, stop-loss carriers, and TPAs a fuller, more current picture of the market.


Key Advantages for Prospective Clients

● Rapid innovation: Enhancements delivered through a monthly sprint cycle

● Multi-network visualization: Upset Plot and map-based comparison across more than two networks at once

● Expanding data completeness: Medicare-equivalent repricing now extended to APR-DRG and CSTM-ALL billing code types

● Presentation-ready output: PDF and PowerPoint export now available across Tier Comparison, alongside existing export areas