Contract Review
Demo sampleYour underpaid CPTs, ranked by per-unit gap to your local-peer median — the defensible renegotiation worklist to take to each payer.
That's a sample BH group. Drop your NPI to surface the exact parity gaps — your BH codes vs the local-peer median and their medical equivalents — to take into your next rate renegotiation. No PHI, no card.
10 underpaid codes · $416,920 in annual opportunity vs your local-peer median · demo sample · modeled, never a guarantee.
Code
Description
Your rate
Peer p50
Target P90 · demo
Recoverable
Memo
Contract red-flags to review
Beyond the rate gaps above — the weak terms that quietly cost you, and the leverage to renegotiate each.
Silent PPO / most-favored-nation
Your rates rented to networks you never joined — cap it or carve it out.
Unilateral amendment / fee-schedule change
Payer can cut rates on notice — require mutual written consent.
Timely-filing window
Short windows (< 90 days) forfeit revenue — negotiate 180 days or more.
Prompt-payment / interest
No interest clause is free float for the payer — add statutory interest.
Downcoding / EOB language
Automated E/M downcoding buried in policy — require documented clinical review.
Behavioral-health parity
BH paid below its medical equivalent — the in-force statutes below are the lever.
Fee schedule vs % of Medicare
A % of Medicare drifts down with CMS cuts — anchor to a fixed schedule or a floor.
A review checklist grounded in standard payer-contract terms + in-force statutes. Not legal advice — have counsel review the executed contract.