Expected Rates

We recently added a new section in the RCM designed explicitly for bulk managing Expected Rates. This section provides a streamlined process for creating new Expected Rates, also known as Reimbursement Rates or Allowable Rates, and managing existing ones. This update not only allows users to quickly create expected rates for a practice by utilizing the export/import feature, but it also enhances Contract Managers' ability to update contracted and out-of-network rates faster.

Users and Permissions

User profiles with the Admin designation will not require additional permissions to create and manage Expected Rates. Both Organization Users and Managing Organization Users will require Practice Access. To read more about this, click here.

Create New Expected Rates

Creating expected rates has never been easier! Let's review the new and improved method of adding a Payer Rate.

Navigate to the Practice Admin > Insurance Payers > Expected Rates.
Click Add New Expected Rate.
In the Add New Expected Rate window, update the Payer dropdown. If you do not see the payer name listed, click here.
Next, update the Service dropdown.
And the Service Billing Profile dropdown.
Enter the expected reimbursement rate in the Amount field.
After entering the amount, update the Contract Status field to indicate Contracted or Not Contracted.

Note: Contracted or Not Contracted will appear as In-Network (IN) or Out-of-Network (OON) on several reports.

Update the defaulted Effective Date when applicable.
Add a Review Date to set a follow-up reminder to review the current contracted rate.
And update the Date Type dropdown when applicable. This field determines how and when the system applies the rate.
Finally, click Create to complete the process.

Importing Expected Rates

This feature was designed to provide contract managers with a fast and accurate method of creating and managing multiple Expected Rates simultaneously. Data files saved in any of the following formats can be used to import Expected Rates in bulk: .csv, .tsv, .xls, .xlsx, .xml, and .txt spreadsheets. Click here for a blank template. In addition to creating new Expected Rates, this workflow can also be used when managing existing Expected Rates using the Import feature. Let's review how to import Expected Rates!

1. To bulk add Expected Rates, select Import Expected Rates.
2. Click Upload File to select the document you wish to import. If the file upload is successful, you will receive a notification indicating that the file has been uploaded and the sheet(s) have been loaded.
3. If the file upload is successful, the system will ask you to map the columns of the document with their destination fields in the RCM.
4. Click Continue after you have finished mapping the data to the fields in the RCM.
5. In the review screen, the system will identify any rows that could not be mapped in red. Hover over the red fields to identify the root issues and click Transform to update the information and resolve the Issue.
6. Once the errors have been resolved, click Submit to complete the import process.

Managing Existing Expected Rates

Managing Expected Rates is now simpler. Users can update Expected Rates, status, review date, and deactivate rates in bulk or individually. In addition, the user interface provides a more comprehensive overview of established Expected Rates to ensure that all rates are accurate and up to date. This interface can be further customized by selecting the View Columns button to add/omit any columns from your view.

Column Names and Definitions

Column Name	Definition	Where to Edit
Payer	This is the name of the Payer.	Practice Admin > Payers > Payer.
Service	This is the name of the Service the rate will be applied to.	Practice Admin > Services > Service.
Billing Profile	This is the name of the Billing Profile the rate will be applied to.	Practice Admin > Services > Service > Billing Profile.
Expected Rate	This is the expected reimbursement rate for the service rendered.	Practice Admin > Payers > Expected Rates.
Level of Care	This is the Level of Care the service is mapped with.	Practice Admin > Services > Service > Billing Profile.
Revenue Code	This is the Revenue Code associated with the Billing Profile selected.	Practice Admin > Services > Service > Billing Profile.
Procedure Code	This is the HCPCS or CPT code associated with the Billing Profile selected.	Practice Admin > Services > Service > Billing Profile.
Effective Date	This is the first day the payer rate will be applied.	Practice Admin > Payers > Expected Rates.
Date Type	This field displays how/when the system applies the rate.	Practice Admin > Payers > Expected Rates.
Review Date	This is the day a reminder will be generated to advise the user to check the status of their contract.	Practice Admin > Payers > Expected Rates.
Contract Status	This indicates whether the provider is in-network or out-of-network for the service with that payer.	Practice Admin > Payers > Expected Rates.
Set Status	This indicates if/when a payer rate has been updated. Statuses that display Baseline indicate that no updates have been made since their original creation.	Practice Admin > Payers > Expected Rates.

Manage Expected Rates

1. Locate the expected rate you wish to change.
2. To alter the expected rate on future claims, click Add Change Set.
3. To update the expected rate from the baseline (and all previously billed claims), click on the three dots icon and select Edit Change Set.
4. Add the Effective Date of the changes.
5. Then update any applicable remaining fields before clicking Save to complete the process.