Parity Gap
Demo sampleFederal parity law (MHPAEA) bars systematically worse behavioral-health reimbursement. This scores your BH codes against the local-peer median — the data to test parity.
Payers that pay BH codes below their medical equivalents are exposed to parity inquiries — this gap is your negotiation lever.
In this sample, Anthem Blue Cross pays 86% on medical vs 64% on behavioral — a 22-pt documented spread.
See how to cite thisThat's a sample client. One NPI scores that client — then roll your whole book into one ranked triage view.
Modeled from the local-peer distribution · documented opportunity, never a guarantee.
Not relied on: the 2024 MHPAEA Final Rule — under federal non-enforcement since 2025-05-15 pending the ERIC litigation.
State enforcement beyond the federal floor where applicable: CA (SB 855), NY, CO, MA, IL. The packet assembles this NPI's parity figures + these in-force citations into a one-page renegotiation memo — on-device, no PHI. Not legal advice.
This gap is the quantitative parity signal. CAA-2021 also requires the plan to prove its non-quantitative limits are comparable for BH vs medical. Request the comparative analysis and test:
- Prior authorization / precertification frequency + criteria
- Step therapy / fail-first requirements
- Concurrent + retrospective utilization review intensity
- Network admission standards + reimbursement rates (this rate gap is Exhibit A)
- Out-of-network reimbursement methodology
- Written medical-necessity / level-of-care criteria
- Provider-directory + network adequacy
Documented parity gap from 500+ payer contracts · 314M+ federal rate records. Supports an MHPAEA inquiry or renegotiation. Not legal advice.