Why we print our prices and what the number buys.

We would rather the number be on the page before anyone picks up a phone. An owner can read it, total it and budget before the first call.

Why enrollment can be printed and billing cannot.

A quote is fair when the size of the work cannot be seen from outside. Billing is like that. Its cost depends on claim volume, the payer mix and how much of the work stays in your office, and a vendor that guessed at it on a web page would be guessing wrong for most readers.

Enrollment has a different shape. Each payer takes a separate application for each provider, and the practice itself often needs one too.^A The owner knows the provider count and the payer list before any call. Once the units are known, the price is arithmetic.

Ours reads like this. $350 for each organization application, $250 for each practitioner application, and $150 to set up a provider's CAQH profile.^B A solo practice files one application per payer, at $350. Two providers with five payers comes to $4,550, and the calculator on our pricing page will show you the same figure line by line.

What a printed number lets an owner do.

It lets you budget before you spend an hour on the phone. It also lets you hold two vendors side by side.

Read the unit before the figure. A fee per provider and a fee per provider per payer can differ several times over once a practice needs five or six payers. Ours is per application, and every line of the calculator on our pricing page names its unit. If a vendor needs a call to tell you the unit, that tells you something too.

What the fee does not buy.

A payer decides whether its panel is open and when it approves an application. No fee changes either decision, ours included. Timing belongs to the payer too. Commercial plans take months to answer, Medicare tends to be quicker, and each state runs Medicaid at its own pace.^A

The fee pays for the part we control. Each application is filed, then followed until that payer sets an effective date or answers in writing, and the Friday board shows where every one stands. The Sprint is prepaid, on one invoice at signing, so the number you saw on the page is the number you are billed.

What we leave off the page.

Billing has no printed price here, and it is half of what we do: eligibility, authorizations, claims, posting, denials and appeals, underpayments and reporting. A billing figure written before we have seen your claims would be a guess. We set it from the practice's own numbers, in a written agreement after the review.

Questions worth asking any vendor.

Is the fee per provider, per payer, or per application? Does it cover following each application to an effective date, or only filing it? When is it invoiced? What happens to the fee if a payer's panel turns out to be closed? A vendor who answers all four in writing, before a sales call, is one you can compare. That includes us.