Payer Rates [Limited Release]

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 recently added a new section in the RCM 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, and managing existing ones. This update also allows users 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.

Navigate to the Practice Admin > Payers > Payer Rates.
Click the Add New icon.
In the Add New Payer Rate window, update the Payer name. If you do not see the Payer name listed, click here.
Next, select the Service and Billing Profile the rate should be applied.
Select the Effective Date before entering the Payer Rate.
After entering the rate, update the Status 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 Review Date to trigger a reminder to check the rate at a future date and 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. In addition to creating new payer rates, this workflow can also be used when managing existing payer rates using the Import feature. Let's review how to import payer rates!

1. To bulk add Payer Rates, select Import Payer Rates.
2. Select 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 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

In the Payer Rates window, select one or more existing rates you'd like to update.
Next, click the pencil icon to edit.
Select the field you would like to update and input the changes.
Click the plus icon to change additional fields.
Finally, click Save to complete the process.