Every payer relations team walks into a renewal with a feeling about where their rates stand. MedReveal turns that feeling into a percentile, a market median, and a dollar figure you can put in front of the payer's negotiator — before the term sheet arrives, not after.
"Our rates feel low" does not move a payer. "We are at the 24th percentile on our top three E&M codes, worth $64K a year at current volume" does.
See where every code in the contract actually sits against the market before you decide what to ask for — and what to concede.
A flat annual bump or a missed rate-reopener deadline is money left on the table every renewal cycle. Know your dates and what a real increase should look like.
If your contract ties your rate to another payer's, you need to know what that payer is actually paying the market — not just your own number.
Your UHC agreement renews in six weeks. The rate for your highest-volume E&M codes has not moved since the last amendment, and payer mix has quietly shifted more of your volume onto this contract. You do not need a hunch — you need the fee schedule review. Here is what it turns up.
| Code | Current rate | Percentile | Market median | Gap / visit | Annual volume | Annual opportunity |
|---|---|---|---|---|---|---|
| 99213Level 3 office visit | $52.00 | 24th | $62.15 | +$10.15 | 3,000 | +$30,450 |
| 99214Level 4 office visit | $78.00 | 24th | $92.50 | +$14.50 | 1,800 | +$26,100 |
| 99215Level 5 office visit | $108.00 | 21st | $127.60 | +$19.60 | 400 | +$7,840 |
| Total annual opportunity, these three codes | $64,390 | |||||
Market medians are real MedReveal query results — UHC published negotiated rates, Family Medicine, professional claims, Texas. Current rate and annual volume are illustrative, standing in for the TIN-specific rate and utilization pull a real contracting team runs from its own EHR or clearinghouse.
Not "we would like a 5% increase." Instead: three codes sitting at the 21st to 24th percentile of the market, $64,390 a year below what the median provider in the same specialty and state is paid for the same volume. The ask is "bring us to market median" — a target the payer's own negotiator can verify against data they already have access to.
Pull the market distribution for every code in the contract that drives real volume. This is the fee schedule review that should happen before the term sheet, not during it.
Weight the gap between your current rate and the market median by volume. That is your target rate, and the dollar figure behind the ask.
Put the market position and the dollar impact in front of the payer rep. A specific, sourced ask is harder to wave away than a percentage request.
Once the amendment lands, log the new rate and the next reopener or escalator date — so the next renewal starts from data, not memory.
Build the fee schedule review before the payer sends the term sheet, so you are proposing, not just responding.
Most contracts allow an off-cycle rate reopener under specific conditions. Know when your rates have fallen behind the market enough to invoke one.
Before agreeing to a capitation or shared-savings arrangement, compare it against the fee-for-service market it is meant to replace, code by code.
See which payer in your mix is furthest below market. That is the contract to prioritize this renewal cycle, not the one that happens to be up first.
Send us your top codes and payer set. We will come back with the market position and the dollar figure behind the ask.