Iris glossary
Plain-language definitions for Iris reports, data sources, pricing measures and healthcare terms.25 definitions
Network Evaluation
A side-by-side comparison of how networks perform on cost, disruption, and access for a specific employer group.
Care Steerage
A report that identifies the most cost-effective, high-quality providers within a single network for a specific employer group.
Rate Lookup
A tool for finding contracted rates for specific procedures, billing codes, and carriers without running a full report.
Claims Repricing
A tool that reprices an employer's actual claim lines across one or more networks to project what that spend would have cost under a different carrier.
Disruption Analysis
A model of the provider access impact of a network change, showing which providers would fall out of, partially into, or remain in-network under a new carrier.
Incumbent network
The network the employer currently uses. The baseline against which all comparisons are measured.
Comparison network
An alternative network evaluated against the incumbent (up to five per report).
Simulated claims
Modeled claims Iris generates when an actual claims file isn't available, using a large commercial claims database and the group's demographics.
Claims file
An employer's historical medical claims (typically last 12 months), used for dollar-level accuracy in analysis.
Provider weights file
A file listing the NPIs the employer's population uses, weighted by total spend. Sharpens both cost and disruption analysis.
Census file
A roster of covered members (ZIP, age/DOB, gender) that improves location-based modeling and disruption scoring.
MRF (Machine-Readable File)
The carrier-published file of contracted rates for every billing code, required under the Transparency in Coverage rule.
Price transparency data
Rates sourced directly from carrier MRFs.
Derived / actuarially adjusted data
Rates estimated from MRF patterns and claims benchmarks, used to fill gaps where MRF data is missing or flagged as an outlier.
Data coverage
The percentage of employer claims cost priced via MRF data vs. derived estimates, shown per carrier per setting of care.
Data quality
A measure of how reliable the MRF-sourced rates are, assessed by comparing published rates against paid claims benchmarks.
Confidence score
A 0–100 score measuring how reliably a published rate aligns with expected market pricing across multiple benchmarks. Strong = above 70; Moderate = 50–70; Low = below 50.
Setting of care
Where care is delivered: inpatient, outpatient, or professional.
MSA (Metropolitan Statistical Area)
A geographic grouping used to localize comparisons based on where members live and receive care.
Provider Control Center
A Care Steerage feature for customizing the provider set by clinical category, with live updates to the report summary.
Blinded demo
A report view that anonymizes carrier and provider names for use when presenting to prospects.
Quick Wins
Top clinical categories by projected cost savings in a Care Steerage report, ranked by savings only (not quality).
CMS quality score
A 1–5 provider rating based on CMS's quality methodology. 5 = highest quality.
NPI (National Provider Identifier)
The unique ID for a healthcare provider.
NAICS code
An industry classification code used to refine demographic and claims modeling.