Payer Rates [Beta]

This feature is currently in limited release to a select group of clients and will be rolling out to everyone in the coming months.

We have recently added a new section in Avea specifically designed for bulk managing Payer Rates. This section is intended to provide a streamlined process for creating new Payer Rates, also known as Expected Rates or Allowable Rates, as well as managing existing ones. This update also gives users the ability to quickly create payer rates for a practice by utilizing the export/import option.

Users and Permissions

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

Creating New Payer Rates

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

• 1. Navigate to the Practice Admin > Payers > Payer Rates.
     
  2. Click the Add New icon.
     
  3. In the Payer Rate window, update the Payer name. If you do not see the Payer name listed, click here. 
     
  4. Next, select the Service and Billing Profile the rate should be applied.
     
  5. Select the Effective Date before entering the Payer Rate.
     
  6. After entering the rate, update the Status to indicate Contracted or Not Contracted.
     
  7. Note: Contracted or Not Contracted will appear as In-Network (IN) or Out-of-Network (OON) on several reports
  8. Finally, select the Review Date to trigger a reminder to check the rate at a future date.
      
  9. Click Add Rate to complete the process.
     

Importing Payer Rates

This feature was designed to provide contract managers with a fast and accurate method of creating and managing multiple payer rates at the same time. Data files saved in any of the following formats can be used to import Payer Rates in bulk: .csv, .tsv, .xls, .xlsx, .xml, and .txt spreadsheets. Click here for a blank template. Let's review how to import payer rates!

• 1. To bulk add Payer Rates, select Import Payer Rates.
     
  2. Select Upload data from 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. Select Continue.
     
  4. Next, confirm the data points in the document to the data fields in Avea to map the correct information accordingly.
      
  5. Select Confirm Mapping to import the data. If any of the information is incorrect or unnecessary, select Ignore this column to stop it from being imported.
      
  6. After you have completed the mapping, scroll to the bottom and select Review.
     
  7. 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. 
     
  8. Once the errors have been resolved, select Continue to complete the mapping process.
     

Managing Existing Payer Rates

Managing payer rates is now simpler. Users can update payer rates, status, review date, and deactivate rates in bulk or individually. In addition, the user interface provides a more comprehensive overview of established payer 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
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.
Payer	This is the name of the Payer.	Practice Admin > Payers > Payer.
Payer Rate	This is the expected payment amount of the service rendered.	Practice Admin > Payers > Payer 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 > Payer 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 > Payer Rates.
Contract	This indicates whether the provider is in-network or out-of-network for the service with that payer.	Practice Admin > Payers > Payer Rates.

Updating Payer Rates

• 1. Navigate to the Practice Admin > Payers > Payer Rates section.
  2. To update the Payer Rate, Effective Date, Contract, or Review Date, click on the data field you wish to alter.
     
  3. Enter the new information in the desired field.
     
  4. Click anywhere on the screen to save the changes.
  5. You can also change the details of a payer rate using the edit function by selecting the box to the left of the Service Name.
  6. After the selection has been made, locate the Pencil icon to edit the rate.
     
  7. In the Edit Payer Rates window, update the dropdown to the desired change
     
  8. After the change has been selected, input the additional data required.
     
  9. Once the data has been updated, the system will generate a plus sign icon. This icon can be used to make additional changes to the rate.
     
  10. After all fields have been filled out, select Save to finish updating the rates.
      
• To update multiple rates at once, make sure all selected rates are for the same payer.
  
  
  1. Navigate to the Practice Admin > Payers > Payer Rates section.
  2. Identify each rate you'd like to update by selecting the boxes to the left of the Service column.
  3. After the selections have been made, locate and select the Pencil icon to edit the rate.
     
  4. In the Edit Payer Rates window, update the dropdown to select the desired change.
     
  5. After the change has been selected, input the additional data required.
     
  6. After including the additional details, the system will generate a Plus Sign icon. This icon can be used to make multiple bulk updates at once.
     
  7. After all fields have been filled out, select Save to finish updating the rates.
     
• 1. To manage payer rates using the import feature, first select Download Import Template.
     
     
  2. In the downloaded template, edit any applicable fields to instruct the system what changes are needed.
  3. Next, save the template to your device.
  4. After, select Import Payer Rates.
     
  5. Select Upload data from 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.
     
  6. Select Continue.
     
  7. Next, confirm the data points in the document to the data fields in Avea to map the correct information accordingly.
      
  8. Select Confirm Mapping to import the data. If any of the information is incorrect or unnecessary, select Ignore this column to stop it from being imported.
      After you have completed the mapping, scroll to the bottom and select Review.
     
  9. 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. 
     
  10. Once the errors have been resolved, select Continue to complete the mapping process.
      

Available Updates and their Definitions 

• Effective Date: This date helps this system identify which dates of service the rate should apply to.
• Payer Rate: This amount will instruct the system what to change the payer rate to. To update a payer rate for the past/future, select an Effective Date.
• Status: This label indicates whether a rate is Contracted or Non-Contracted. In Avea reports, this will display as IN (In-Network) or OON (Out-of-Network.)
• Review Date: This date will create a system reminder that advises the user to review the existing rate. 

• Payer Rates Template.xlsx 10 KB