How to rank your payers by their rate for your top code
Most commercial health plans post the rate they negotiated with each clinician, code by code. The next payer you negotiate with can read yours.
Co-founder, JotPsych
Your contract with a commercial payer is up for renewal. Your clinicians bill that payer for 90837 and 99214, and you're deciding what rates to ask for.
One entry in the federal format for public rate files. Any payer can download a file and read your rate beside your clinician's provider number.
What the public rate files show
Most commercial health plans have posted their rates in public files since July 2022, under a federal rule. Each entry also gives the date the contract for that rate ends. Plans update the files monthly.
Three steps to rank your payers
- Pull each payer's rate for your top code. Take each rate from the payer's contract or fee schedule: a payment leaves out your patient's copay, coinsurance, or deductible. "Find out exactly what you're gonna be paid in dollars and cents for all of the CPT codes that are important to you," said Doral Jacobsen, who negotiates payer contracts.
- Rank your payers from highest rate to lowest. Jacobsen compares the rates "payer to payer." "The payers can see what you're accepting from all the other payers," Jacobsen said, and payers quote other payers' rates to her team "on the regular."
- Renegotiate the lowest rate first. Jacobsen tells you to look at contracts where you're "accepting really low rates," because "that could come back and bite you." Your lowest rate is the one the next payer can quote.
Few medical groups use the files in payer negotiations. Most groups that skip the files cite unclear value or a lack of awareness, tools, time, or skills.
A Medical Group Management Association poll of 207 medical group leaders, December 30, 2025, on using payers' public rate files in negotiations. You can rank your payers without the files.
After your top code, repeat the ranking for each code that's important to you.
Your fee schedule in JotPsych keeps each payer's contracted rate by code.
Book 15 minutes- Doral Jacobsen, chief executive officer of Prosper Beyond, “Strategic Revenue Cycle Workplan Design for High-Impact Payer Engagement,” workshop WS1, Medical Group Management Association (MGMA) 2026 Annual Conference, San Antonio, September 27, 2026.
- Centers for Medicare & Medicaid Services, Transparency in Coverage Final Rule fact sheet, October 29, 2020.
- U.S. Department of Labor, Frequently asked questions about Affordable Care Act implementation, part 49, August 20, 2021: enforcement of the rate files from July 1, 2022.
- Centers for Medicare & Medicaid Services, Price transparency guide, in-network rates schema, read September 30, 2026.
- Code of Federal Regulations, title 45, section 147.212, Transparency in coverage, paragraph (b), via the Legal Information Institute, Cornell Law School.
- Medical Group Management Association, MGMA Stat poll on Transparency in Coverage data in payer contract negotiations, December 30, 2025, 207 applicable responses.