Payer contracting intelligence, in the open.

National Provider Identifier

A unique 10-digit identification number issued by CMS to healthcare providers. Required for billing payers and enrolling in plans.

Reimbursement Agreement

The binding agreement between a provider organization and an insurance payer that sets rates, terms, and covered services for care delivered.

Rate Table

The list of contracted rates a payer will reimburse for each procedure code (CPT/HCPCS). Gaps between your fee schedule and market benchmarks drive underpayment.

Provider Onboarding

The verification of a provider’s qualifications, licenses, and history before a payer will authorize them to bill. Often a 60–120 day bottleneck.

Credentialing Data Source

A standard self-reported provider profile that most payers use as the starting point for credentialing. Keeping it current prevents enrollment delays.

Short-Pay

When a payer reimburses less than the contracted rate for a claim. Recovering short-pays typically returns 4–9% of net revenue.

Payment Matching

Matching remitted payments against contracted rates to surface underpayments, denials, and missing reimbursements before they age out.

Electronic Payment

Electronic Funds Transfer and Electronic Remittance Advice — the standard digital channels through which payers pay providers and report adjudication.

Error-Free Submission

A claim that requires no additional information to be processed. Payers contractually must pay clean claims within state-mandated timeframes.

Billable Authorization

The point at which a provider is fully contracted and credentialed with a payer and can begin submitting claims for reimbursement.

Management Services Org

An organization that handles contracting, billing, and administrative operations on behalf of independent provider groups, often at scale.

Independent Practice Assoc.

A network of independent physicians that contracts collectively with payers to negotiate rates and manage enrollment on behalf of members.