Open Payment System
Introducing Standard Service Packages (SSPs)
Today's episode groupers are proprietary and rely on outdated logic, contributing to widespread industry fragmentation as providers and payers implement bespoke processes to support them. They offer no clear delineation between services, encounters and episodes, making it nearly impossible to know when and how to tie facility and ancillary fees. For providers and payers, this complexity drives administratively costly claims denials and appeals processes. For patients, it means almost never being able to predict what you'll pay for healthcare.
Standard Service Packages (SSPs) consolidate all medical services, materials, and fees associated with a healthcare procedure into a single code. They are open-source (and always will be), patient-first, compatible with existing transaction standards and clearly distinguish between services, encounters, and episodes.
For Providers and Payers, SSPs streamline billing and payment, dramatically reducing administrative overhead, claims denials and appeals. The result? A collapsed revenue cycle and improved margins.
For Patients, SSPs pave the way for a frictionless healthcare financial experience. SSPs enable you to not only predict the cost of healthcare, but settle your balance upfront.
We have released a small subset of our SSP library, with more being published on a rolling basis. The sampling below focuses predominantly on shoppable services and procedures. Explore the table to see how they work.
SSP Code | Category | Type | Status |
|---|
What is a Standard Service Package?
Standard Service Packages (SSPs) are a bundle of codes that represent what actually gets billed alongside a primary procedure code. These include revenue codes, professional fees, labs, drugs, etc.
SSPs adhere to the following heuristic:
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Clinical Similarity & Relevance
- Sub-packages have the same level 2 / 3 CPT Hierarchy OR…
- Sub-packages have the same clinical categorizations defined by TQ
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Cost Similarity
- The clinical sub-packages that comprise an SSP have Medicare Outpatient Prospective Payment System (OPPS) reimbursement that varies no more than 12.5% or $400
- Across 10,000 encounters, the distribution of commercial negotiated rates follows a normal distribution and no sub-package has a deviation of ≥ 12.5% or $400 from that SSP’s average negotiated rate
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Consumer Comprehension & Relevance
- Perhaps most importantly, SSPs must be consumer-first meaning they intuitively reflect the way a patient can expect to find, receive and ultimately pay for care.
What is included in a SSP?
- A unique, five digit alphanumeric code.
- An applicable name describing the package. This includes a name, description of services rolled into each package & clinical description of services provided.
- Categorization and tagging related to the status, cost, frequency and service type of that package.
- Bundled services, codes & fees that are billed in association with a service.
Fee schedule
Every consumer-friendly SSP is mapped to a Medicare APC rate. This allows group purchasers and providers to set reimbursement terms off a base % of Medicare, which is familiar and common to the industry. Over the coming weeks, we'll release a regional fee schedule tailored specifically to SSP codes that users may adopt as a base rate for negotiation.
Implementation guide
Grouper
The SSP Claims Grouper is an open license grouper that developers may use to group claims and pre-claim estimates to a Standard Service Package.
We offer two variations:
- A UI-based grouper that takes simple claims / encounter inputs and returns the SSP they map to. This is intended to visualize how the API based grouper works, but is simplified for ease of use.
- An API-based grouper that allows users to group claims in bulk. This accepts more inputs and offers a more granular mapping output. In the first half of 2025, we will release an open-license version of this grouper for healthcare developers to run locally within their organizations if desired.
Product Information
At least one CPT / HCPCS code is required to proceed. A maximum of 15 codes is permitted.
Diagnosis Information
Result
The SSP associated with your code entries will be displayed here.