Negotiation Playbook
Choose a situation first. What is useful to write here is different for a rate ask and for a clawback.
Paste as much as you have: what the client told you, what the payer said on the last call, what you already tried. This note is background for the writing only. It can never change a rate, a target, a date or a code: every figure is computed before the model sees anything.
Add the practice’s own files · optional, an 835 remittance
Add the practice’s own files
Drop an 835 remittance or the payments export from the practice management system, and every figure it covers is marked sourced from the practice’s own file, instead of modeled from published rate data. Published rates estimate. Remittance proves.
Drop 835 remittances or a payments export (CSV, Excel)
.835 · .edi · .era · .csv · .tsv · .txt · .xlsx · .xls
The file is read in this browser and is never uploaded. Only the columns that carry codes, payer, amounts, units and denial codes are read. Patient names, member ids, dates of birth, account and claim numbers and every other column are counted and destroyed during the parse, and exact dates are reduced to a year, before anything appears on screen. Nothing from the file is retained after you leave this page.
This playbook is built on mechanism and statute, not on a win rate.
There is no published case of a dental practice citing transparency data and winning a documented commercial rate increase. So every step below is something you can check for yourself, sourced to a statute, a court, a payer's own policy, or a professional association.
About this tool
One practice, one payer, one situation. What to do, in what order, with the evidence under each step and the answer for what they say back.