Leverage Memo
ProDemo sampleA per-payer memo: every underpaid code on the contract, the local-peer percentile, the math, and a specific time-boxed ask, on signable letterhead.
Roll up every client NPI into one ranked book. Book a call to set up your whole-book roll-up.
Each client's underpaid codes ranked in flat dollars against the local-peer median, sized for appeal and renegotiation across your whole book. Documented opportunity, never guaranteed.
Re: Fee schedule review, our practice, 6 codes below local-market target
Our practice requests a review of our commercial fee schedule for the 6 codes currently reimbursed below their local-market target, set out in Exhibit A.
The evidence table sets each code's current contracted rate against the local peer median (P50) and the P90, the top of the local market. The final column is a documented reimbursement opportunity, modeled from public rate data and not guaranteed.
The largest single gap is on 59400 (Routine obstetric care (global OB)): currently $2,980.00 against a local 75th percentile (no local P90 for this code) of $3,960.00.
Aligning these rates to the local market supports network adequacy and member retention. Competitive contracted rates keep this practice in network for your members and reduce the access disruption that follows when a participating provider leaves the network.
We request that the codes in Exhibit A be adjusted to the top of their local market, the P90 where a local P90 exists, effective on renewal. Please provide a written response within 21 days and a meeting with the network contracting manager to review the schedule.
| Code | Your rate | Peer P50 | Local target | Specialty cohort (reference) | Gap / unit |
|---|---|---|---|---|---|
| 59400 | $2,980.00 | $3,680.00 | PRO† | no specialty cohort held | — |
| 99214 | $128.00 | $158.00 | PRO† | no specialty cohort held | — |
| 99213 | $92.00 | $112.00 | PRO† | no specialty cohort held | — |
| 45378 | $408.00 | $498.00 | PRO† | no specialty cohort held | — |
| 20610 | $68.00 | $96.00 | PRO† | no specialty cohort held | — |
| 93306 | $198.00 | $246.00 | PRO† | no specialty cohort held | — |
† The rate engine returns each target without the peer population it was computed from, so these targets are not attributed to a named cohort. The specialty cohort beside them is a separate reference figure and did not produce them. Do not describe an unattributed target as a local peer figure in the letter.
Reddenda · documented opportunity from public rate data. Modeled, not guaranteed; payer acceptance is not assured.