ANSWERS · PAYERS

How do I get my fee schedule from a payer? (They resist — here's how.)

You're entitled to the contracted rates you agreed to, but payers rarely hand over a full fee schedule easily — so ask specifically and in writing. Request the rates for your top CPT codes by referencing your contract and the payer's provider-manual process, and if they stall, escalate to your network contract manager, because you can't detect underpayments without the numbers you agreed to.

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Step by step

1
Start with your contract
The agreement references how rates are set (often a percentage of a Medicare year) — that language is your basis for the request.
2
Request specific codes in writing
Ask for the allowed amounts on your highest-volume CPTs by name; a targeted request is harder to ignore than "send the whole schedule."
3
Use the provider portal and manual
Many payers post a fee-schedule lookup or a request process in the provider manual — use the documented channel.
4
Escalate to contract management
If the call center stalls, go to your network/provider-relations contract manager, who can actually produce rates.
5
Reconstruct from remittances if needed
Where a payer won't produce it, your paid-claim history reveals the effective allowed amounts to compare against.

Common questions

Am I entitled to my payer fee schedule?

You're entitled to know the contracted rates you agreed to — that's what you're being paid on. Payers often make it difficult, but a written, code-specific request tied to your contract, escalated to contract management, usually gets results.

What if the payer just won't give it to me?

You can reconstruct effective rates from your own paid-claim remittances — the allowed amounts on past claims reveal what the payer is actually applying, which is enough to spot underpayments even without the official schedule.

Where Volari fits: Without your fee schedule, underpayments are invisible — Volari reconstructs effective allowed amounts from your remittances and flags where the payer is paying below the rate you agreed to.

Related answers
How do I lower my practice's denial rate? →How do I reduce days in A/R? →How do I read an EOB or 835 remittance? →How do I know if I'm being underpaid by insurers? →In-house billing vs. outsourcing: which is right for my practice? →How do I renegotiate payer contracts for better rates? →

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