Fee Schedule Review Enrollment

Submit your office, provider, payer, and fee schedule documents for review.

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Office
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Provider
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Payer Review
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Documents
5
Review & Payment

Office Information

Enter the practice details for the office requesting the fee schedule review.

Provider Information

Provide your professional details.

Payer Information

Information about the payer to be reviewed.

At least 12 months of payer production data is generally required before we can accept a fee schedule negotiation request.

Required Documents

Upload the necessary documents to proceed.

Current Payer Fee Schedule *
Upload your current payer fee schedule.
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PDF, Excel, or CSV

Office Standard / UCR Fee Schedule *
Upload your office standard or UCR fee schedule.
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PDF, Excel, or CSV

12 Months of Production Data *
Upload at least 12 months of payer production reports.
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PDF, Excel or CSV

Top CDT Code / Procedure Report *
Upload the report for your top CDT codes or procedures.
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PDF, Excel or CSV

Provider Agreement or Contract (if available)
Upload any existing agreements.
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PDF

Sample EOBs (if available)
Upload sample EOBs for this payer.
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PDF

W-9 Form
Upload a current W-9 form.
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PDF

Authorization & Payment

Review and authorize the fee schedule review.

Review Fee

$50 per payer review

Total Due

$50.00

Your payment is secure and encrypted.

Once submitted, our team will review your information and contact you if additional documents are needed. If the payer qualifies, negotiation service will be offered separately before we contact the insurance company.