Requesting contracts and fee schedules from insurance payers can become a long and unrewarding process. Rivet can help point you in the right direction for some of the most common payers. Read about the proven efforts you can try for the following payers:
The process for requesting documents will differ slightly if you are requesting a contract vs a fee schedule. In this context, a contract refers to the signed agreement between you and the insurance payer. The contract often includes contract terms (e.g., timely filing, clean claim payment, etc.) as well as fee schedule information (e.g., 100% of CMS). However, requesting an isolated fee schedule more often results in a spreadsheet of allowed amounts per procedure code. For Rivet’s purposes, we often need both a contract and a fee schedule.
1. Aetna
Process for requesting a contract from Aetna:
Send a contract request to the appropriate Aetna representative.
If a provider representative contact information isn't available, you can send a fax request to 859-455-8650 ATTN: Network Account Manager
Make sure to include a list of ALL providers and NPI's on a second page, and reference this list in the main request.
Follow up after 3 business days by calling 800-353-1232, and selecting opt. 3 for credentialing. Then stay on the line as you get connected to the representative automatically.
Once you have confirmed that the request was received, it can be helpful to call again within a couple weeks to confirm the request is still being worked on. Aetna has 30 business days to provide documents from the time the request is received, but you will want to make sure it doesn't get lost in the queue.
Process for requesting a fee schedule from Aetna:
Download or compile a list of all relevant codes that you bill. Put this list in a spreadsheet (such as Microsoft Excel or Google Sheets). This list of codes will tell Aetna which codes they should include in your fee schedule.
Email the spreadsheet to feeschedule@aetna.com to request a copy of the fee schedule. Include the following information in your email.
Practice
Name
Address
Tax ID
Phone number
NaviNet Admin
Contact name
Email
Follow up often to ensure your request was received. If needed, call 800-353-1232, and select opt. 3 for credentialing to follow up with your request.
2. Blue Cross Blue Shield (BCBS)
BCBS has a different process for each state. Below is a list of processes outlined for some states, but note that not all states are listed.
Arizona
Use this link to search for the Network Contract Specialist that you can contact for a fee schedule request.
California
Anthem Blue Cross: Send an email request for a copy of your contract to caontractsupport@anthem.com
Blue Shield of California: Send a signed request (with letterhead) to bscproviderinfo@blueshieldca.com to request a copy of your contract, or call (800) 258-3091 for provider services.
Florida
To request your contract and fee schedules, go to https://www.floridablue.com/
Click on Providers > Forms
Download the Fee Schedule Request Form (PDF).
Form must be signed by an authorized signer and faxed back to the number on the form.
Georgia
Send a request for your contract and fee schedule by doing one of the following:
Call Provider Support: 888-706-3475
Send a signed request through fax: 877-551-6184
Email a signed request to providersupport@bcbsga.com
Indiana
Request your contract and fee schedule by calling Provider Support: 800-676-2583
Kentucky
Send a request for your contract and fee schedule by either calling or emailing one of the following:
East team: Phone: 800-205-5870, email: East.Team-KyProviderEngagement&Contracting@Anthem.com
West team: Phone: 800-205-5870, email: West.Team-KyProviderEngagement&Contracting@Anthem.com
Louisiana
Send a request for your contract and fee schedule by doing one of the following:
Call Provider Support: 1-800-716-2299, option 4
Email a signed request to provider.relations@bcbsla.com
Minnesota
Send a request for your contract and fee schedule by doing one of the following:
Call Provider Support: call 800-262-0820
For contracts, email a signed request (with your Tax ID listed) to Request.contract.renewal@bluecrossmn.com
For fee schedules, email a signed request to fee.schedule.allowance@bluecrossmn.com
Missouri
Send a request for your contract and fee schedule by emailing a signed request to missourinetworkmanagement@anthem.com and providercontractadmin@bcbsmo.com
North Carolina
Send a request for your contract and fee schedule by doing one of the following:
Call Provider Support: 1-800-777-1643, option 6
Email a signed request (with all applicable NPIs) to nm.contracting@bcbsnc.com
Oklahoma
Go to https://www.bcbsok.com/provider/forms/index.html, and download the Fee Schedule Request Form.
Email the filled out form to OKNetworkManagement@bcbsok.com, or fax it to (918) 549-2141
Tennessee
Send a request for your contract and fee schedule by doing one of the following:
Call Provider Support: 800-924-7141
Email a signed request (with signed letterhead) to pno_contractresearch@bcbst.com
Texas
Follow the instructions for each county on this website: https://www.bcbstx.com/provider/standards/standards-requirements/gri/prof-fee-sched-request
If necessary, call 800-749-0966 for provider services, or email provider_relations_dfw@bcbstx.com
Utah
Call 888-367-2119 for provider services
Wyoming
Call 888-666-5188 for provider services
3. Cigna
Process for requesting a fee schedule from Cigna:
Go to Working With Cigna via the HCP Portal
If you do not have access to the HCP Portal, email a request to psscentral@cigna.com with the following information:
Subject line: Fee Schedule Request
Body:
Tax ID
Practice Name
Contact name and phone number
Practice address
Mailing address
Explain that you are unable to request via the HCP portal
This process takes about 30 business days.
2. Scroll down to the bottom right and select Request Fee Schedule
3. Fill in the following information and hit Submit
4. Do this for each Plan type
5. Check back in 24 hours to pull the fee schedules from the secure inbox
6. If you are experiencing issues:
Call 1-800-882-4462 for Cigna Provider Services.
Enter Tax ID
State "Credentialing"
Enter 1 for Medical
4. Humana
Process for requesting a fee schedule from Humana:
Call Provider Relations at 1-800-626-2741.
Provide Tax ID number when prompted.
Respond "Yes" when asked if you have received a letter.
When asked the purpose of your call, explain that you would like a full copy of the Humana fee schedule.
Give them all relevant information they ask for: Tax ID, practice name, etc.
Check email for FULL fee schedule in Excel format.
5. United Healthcare
Process for requesting a contract and fee schedule from UHC:
1. To request a copy of the full fee schedule login to http://www.uhcprovider.com/networkhelp
2. Start a live chat with UHC which is available Monday-Friday 7 a.m. - 7 p.m CT to request your contract or fee schedule.
3. Once the documents are received, be sure to review them to confirm you have the applicable payment structure and a copy of the payment appendix showing the fee schedules as percentages of CMS rates. Almost all UHC fee schedules are percentages of CMS rates (either current year Medicare or a fixed year), and they will be the most accurate in this form, rather than a spreadsheet form. If UHC sends you only the spreadsheet form, clarify with them by asking for a copy of your contract and payment appendix.
If you have any additional questions about retrieving Contracts and fee schedules from payers feel free to send us an email at success@rivethealth.com.
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