Research & Publications
Independent analysis of ASO agreements, claims integrity, and healthcare pricing transparency.
Current Research Briefs
ASO Agreements and the Hidden Architecture of Medical Claim Pricing: A Transparency Failure
Examines how Administrative Services Only (ASO) agreements and plan documents structure medical claim pricing and adjudication. Identifies systemic transparency gaps in repricing methodologies, SPD and ASA alignment, discretionary claim handling, and outlines public-interest implications for families, unions, and employer-sponsored plans.
- ASO transparency and fiduciary oversight
- Claims integrity and pricing inconsistency
- Document architecture (SPD vs. ASA)
Algorithmic Claim Reductions & Automated Denials in Employer Health Plans: A Public-Interest Review
Analyzes how automated edits, clinical logic engines, and AI-enhanced payment integrity tools influence coverage determinations, reductions, and denials inside employer health plans. Highlights fiduciary risk, false-positive patterns, and the absence of meaningful audit rights for employers and participants.
- Algorithmic claim edits and automated denials
- SPD and algorithm misalignment, and subsequent fiduciary exposure
- Policy recommendations for transparency and auditability
Collaboration & Inquiries
Cost of Care Project welcomes collaboration with employer coalitions, unions, researchers, policymakers, and transparency organizations interested in healthcare pricing, claims adjudication integrity, and ASO agreement analysis.
To discuss research partnerships, co-publication opportunities, or additional work in this area, contact:
Email: info@costofcareproject.org