6 ways to get a fee schedule from a managed care plan

Why This Topic Matters

Fee schedule visibility affects claim payment review, contract negotiation, and a practice’s ability to spot payment variation or missing reimbursement. Understanding the article helps readers evaluate payer transparency issues and identify general avenues for requesting access to pricing information.

Article Sections

1. Why fee schedule access matters

   This section discusses the impact of limited payer transparency on participating practices and the challenges it creates for payment review and contract management.

2. Six strategies to obtain the fee schedule

   This section outlines the broad categories of approaches described for requesting or obtaining fee schedule information from private payers.

3. Include it as part of your contract

   This subsection covers contract-based approaches for making fee schedule access part of the payer agreement and staying informed about updates.

4. Ask for all codes relevant for you, but not for other specialties

   This subsection addresses requesting information tied to the practice’s own service mix rather than broader specialty-specific pricing data.

5. Check the Internet

   This subsection notes that some payer websites may provide fee schedule information for members and participating providers.

6. See if your state law helps

   This subsection discusses state-level disclosure requirements and contacting regulatory resources for guidance.

7. Go to the plan's chief medical officer

   This subsection describes escalating the request within the plan to a physician leader when provider network channels are unsuccessful.

8. Offer to sign a confidentiality agreement

   This subsection covers the option of offering confidentiality assurances to address payer concerns about sharing fee information.