Free where it’s a public good, paid where the savings are.

Much of the network is free — permanently, for everyone. Two simple utility fees fund it all: a flat per-member-per-month participation fee for payers, and one fee for providers on aggregate routed paid-claim volume. No individual transaction carries a charge, no capability is priced separately, and everything patients touch is free. Rates are governed by an independent Council under a lowest-sustainable-fee mandate.

Roads don’t charge by destination. The Internet doesn’t charge per website. Electric utilities don’t negotiate a separate contract for every appliance. Healthcare’s administrative infrastructure should work the same way: published utility fees keep the network neutral, predictable, and inexpensive enough that everyone connects once and reuses the same rails — while patients, public-health reporting, provider connection, and prior authorization stay free at the network layer.

What carries no separate charge — Open Access

Start with what carries no separate charge. “Open Access” describes operation categories that are never separately charged or metered for any participant — patient access, eligibility, public-health reporting, participant onboarding, and baseline conformance testing — not a standalone membership-free plan. There is no separate transaction fee for prior authorization; payer participation remains subject to the published PMPM membership fee, which funds the network, and we say so openly. The paid layer exists to fund the unmetered one. (Certified Network Partner certification is a separate program and buys no routing rights or priority.)

Testing and onboarding: the sandbox and baseline conformance testing carry no SHN fee; managed hosting or partner implementation may involve separate service costs; state funding may cover eligible providers.

The rates — two tracks, one destination

Every participant is on one of two tracks. Standard pricing applies from a participant’s first day on the network, whenever it joins. Launch Participant pricing is the discounted multi-year track for those who commit early: it requires signing by December 31, 2026 — signing, not deploying; your go-live date is assigned by cohort — and completing production certification on the published schedule. On January 1, 2030, the two tracks converge: every participant is on the standard rate named in its own agreement.

Provider fees are metered at your own gateway; prior authorization and eligibility are never metered for pricing. The provider fee is not a share of reimbursement and not a fee on individual claims — routed paid-claim volume is the auditable usage proxy, and SHN does not hold claim proceeds, take assignment of reimbursement, or price on clinical content.

Transaction catalog — go-live calendar

Launch Participant terms cover the whole catalog — the rate terms, not the readiness work. As each release ships, your gateway already has the rails and activation in your market follows within a 90-day window; if a release date moves, the window moves with it. Nothing to re-buy — each release arrives on the same network relationship, without rebuilding a bilateral connection to every counterparty, and activating it is your readiness decision, never a silent update.

Why the prices are small against what they replace

The avoidable administrative waste the network attacks traces to a single defect: at the moment of a transaction, nobody is sure the information is right. Because no one is sure, everyone re-asks — by phone, fax, portal, and letter — and because the answers are still often wrong, everyone pays again downstream: denials, rework, write-offs, recoveries, bad debt. A transaction through the hub is right at the source, once. The work of asking shrinks, and the cost of being wrong shrinks. The savings are money the market already spends. The utility fees are set against each organization’s own share of that waste — computed from your numbers, not asserted from ours.

What a transaction costs off the rails — and on them

The fees are sized against that waste: a payer’s participation fee is on the order of one percent of typical plan administrative spend (published industry benchmarks put core administration in the tens of dollars per member per month); a provider’s fee is five basis points of routed claim volume, against billing-and-insurance costs measured in whole percentage points of revenue. Whether the network clears your fee is not a claim we ask you to take from a website: it is computed from your numbers in a working session — benchmark-based starting points that your volumes, contracts, and costs replace — and every participant sees its own computed fee alongside the cost it displaces on a monthly network statement.

How these numbers are built. The model follows four rules. First, the fee must clear on bankable replacement alone — benchmark-sourced hard dollars (CAQH Index per-transaction costs, AMA prior-authorization burden data) for work that stops existing; everything above that layer is compounding, not justification. Second, moved money is never counted as saved money — a dollar that shifts from one party to another is counted once, as a transfer, never presented as system savings. Third, every return is net of the cost to achieve it — onboarding, integration, and change management are in the denominator. Fourth, outcomes are measured, not asserted: Delaware’s launch measures the outcome layers in production, every participant sees its own computed fee alongside the cost it displaces on a monthly network statement, and the 2030 standard rate arrives with that evidence on the table.

How the rates stay honest

Rates are governed by the independent Council under its lowest-sustainable-fee mandate, with fee-payers recused from decisions on their own rates. The structure removes the incentive to do otherwise: Smart Health Network PBC operates under a public-benefit duty, investor returns are capped, and surplus is reinvested in the network, not extracted.

The Launch Participant window

Launch Participant pricing goes to organizations that sign in 2026 — the window closes December 31, 2026, and the rate locks at signature. When you go live depends on when you commit: signal by September 1, 2026 to plan for the January cohort (RHTP states execute the State Program Contract by September 30); participation agreements execute by November 30, before December production burn-in; sign by December 31 to hold Launch Participant pricing. Sign later in 2026 and you keep Launch Participant pricing — you simply launch with your market’s next cohort, as claims, pharmacy prior authorization, and quality and value-based reporting follow on the target release calendar, subject to launch-participant readiness and governed release approval. One window for the price; quarterly cohorts for the go-live. After December 31, 2026, the published standard rates apply. Each launch cohort has named participants and a defined minimum production scope. Questions about Launch Participant terms →

State program dollars and utility fees are separate. State program dollars may fund state-specific launch work such as provider enablement, records integration, market activation, program operations, and evaluation. Published payer and provider utility fees are participation fees for network use.

State program funds do not pay ongoing payer utility fees unless a state expressly chooses and is legally authorized to do so. The standard model is that payers pay their own published participation fee; state funds may support one-time connection work under neutral, counsel-reviewed criteria.

One connection. Two simple utility fees. Every transaction in the governed catalog — on a published calendar, with a seat you can reserve. See the catalog & roadmap →

Per-transaction benchmarks are published third-party figures (CAQH Index; AMA survey data). Results vary by organization, starting cost, route migration, participation levels, and decommissioning timing; whether the network clears your fee is computed from your numbers in a working session, and each participant sees its own computed fee alongside displaced cost on its monthly network statement.