A contracted rate is the amount an insurance payer has agreed will be paid for services provided. Contracted rates vary based on services and provider. Having these rates on file is recommended so that you always know how much you can expect to be paid.

In this guide, we’ll cover: 

• Understanding contracted rates
• Recording contracted rates
• Adding a contract date
• Billing contracted rates
• FAQs

Understanding contracted rates

A contracted rate is the agreed amount between you and your insurance network that you’ll be reimbursed for a service. This amount includes cost sharing, such as a copay or coinsurance.

Note: In cases where a client hasn’t met their deductible, they’ll typically be responsible for the full contracted rate.

When submitting a claim, you may bill either your full service rate, or your exact contracted rate. If you bill the full service rate, the insurance payer will write off any amount that exceeds your contracted rate. 

If you don’t know your contracted rates or whether a payer prefers that you bill your exact contracted rate, we recommend contacting the payer directly.

Note: A contracted rate can also be referred to as the allowed amount, or included in a fee schedule.

Recording contracted rates

Saving contracted rates in your account makes them easy to reference. You can record contracted rates for each payer you’ve submitted a Payment Report or claim filing enrollment with. 

Note: Adding contracted rates to your account is only so they can be referenced. The rates you enter won’t carry over to other parts of your account, such as claims or your service rates. 

To record your contracted rates:

• Navigate to Settings > Client billing and insurance > Payers
• Locate the payer
  • If the payer isn’t appearing, you can add them to your Payers page by following the steps in Adding insurance payers and selecting the correct payer ID
• Click the payer’s name

• Select the Manage dropdown and choose Contracted rate
  • Each clinician in a group practice can have their own contracted rates added, so long as they have an enrollment on file. Additionally, you can enter contracted rates for the practice under the enrollment submitted with the organization’s information

• Enter the Contracted Rate for each service

• Click Save

Note: If you’re updating your rates, the previous rates will be overwritten and lost once you click Save. You can store documents in your account as Business files, such as previous contracts with insurance payers or records of your previous rates. For more information, see Managing business files.

Adding a contract date

Contracts with insurance payers typically last one year, at which point they may be renewed with updated rates or extended. Having the contract date on file lets you know your rates for a given year are up-to-date. 

To add a contract date:

• Navigate to your Settings > Client billing and insurance > Payers
• Click the payer
• Open the Manage dropdown and select Contracted rate for the the practice or clinician 
• Enter the Contract date beneath the payer’s name

• Click Save

Note: If you’re unsure if your contracted rates are current, or want to know when your contracted rates will be updated, we recommend contacting the payer.

Billing contracted rates

Once you’ve saved your contracted rates in your account, you can reference these when setting your service rates. 

To view your contracted rates with a payer, first navigate to Settings > Client billing and insurance > Payers. Select the payer, then click Manage > Contracted rate for the practice or a specific clinician. Here, you’ll be able to see the contracted rates you’ve recorded for each service:

To bill your clients at a contracted rate, you can navigate to your Services page and adjust your service rates to match the contracted rates. In group practices, a default service rate can also be set for each clinician to match their contracted rate. For information, see Creating and using service codes and products. 

Note: If you prefer to bill your full rates, insurance payers will write off any amount that exceeds your contracted rates. This amount will be listed as the Contractual obligation on Payments Reports.

If you’re in-network with multiple payers with different contracted rates, and would like to bill your exact contracted rate for each, we recommend setting a default rate for each client with a given payer. This will override the practice-level rate settings. To do this, see Setting a default service code and custom rate for a client. 

Tip: To see which clients use each payer, you can visit your Clients and contacts list and filter by insurance payer.

FAQs

• Do I need to enter a contracted rate for all of my services?
• Can I enter different contracted rates for each clinician?
• Which service rate populates the contracted rates page?
• Who is able to see my contracted rates?

Do I need to enter a contracted rate for all of my services?

Entering contracted rates for each service is recommended, but isn’t required. If you currently only know the contracted rates for your most frequently used services, you can enter only these.

Can I enter different contracted rates for each clinician?

Contracted rates can be entered for each clinician in your account if you’re part of a group practice. The only requirement is that each clinician’s NPI has an enrollment submitted. For steps on how to submit multiple enrollments for a payer, see Submitting multiple enrollments per payer.

Which service rate populates the contracted rates page?

Each enrollment’s contracted rates page will also list your current service rates. 

If you’re part of a group practice, each clinician may have their own default service rates listed in the Services page. However, the rate that populates the contracted rates page will always be the practice’s default service rate. 

Who is able to see my contracted rates?

Clients aren’t able to see your contracted rates. Once added, only you have access to this information. If part of a group practice, team members with billing access will be able to see them as well.