Paragon Benefits
Paragon Benefits is a third-party administrator (TPA). For an ASC, what matters isn't the logo. It's how Paragon Benefits pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Paragon Benefits analysis
Tell us where to send it. Our team will prepare an analysis of Paragon Benefits covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Paragon Benefits pays
See how Paragon Benefits reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
See where Paragon Benefits concentrates and how its presence shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Paragon Benefits and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Paragon Benefits's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Paragon Benefits up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Paragon Benefits
- Payer ID
- 58174 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Paragon Benefits through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Paragon Benefits members are verified before the date of service, through a clearinghouse using payer ID 58174or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Paragon Benefits directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Paragon Benefits the way it pays.
- What is Paragon Benefits's payer ID?
- Paragon Benefits's electronic payer ID is 58174. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Paragon Benefits through a clearinghouse.
- How do ASCs verify eligibility for Paragon Benefits members?
- Eligibility and benefits for Paragon Benefits members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 58174) or through the payer's provider portal.
- Does Paragon Benefits require prior authorization for ASC procedures?
- Prior-authorization requirements for Paragon Benefits are set per plan and per procedure. Confirm whether an authorization is required with Paragon Benefits directly before the date of service.
- What type of payer is Paragon Benefits?
- Paragon Benefits is a third-party administrator (TPA).
- How does Paragon Benefits compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Paragon Benefits pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Paragon Benefits paying my ASC below market?
- Put your own Paragon Benefits contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.