Out-of-network shouldn’t mean negotiating blind.
Clarapact shows what payers have actually allowed for behavioral health services on real claims, backed by a citation you can put in front of a payer, a third-party negotiator, or a patient.
Request a demo| Payer | Median allowed | Percent of billed | Claims | 25th to 75th percentile |
|---|---|---|---|---|
| Commercial Payer A | $1,250 | 42% of billed | n = 1,240 | $1,060 to $1,440 |
| Commercial Payer B | $1,380 | 48% of billed | n = 860 | $1,170 to $1,590 |
| Commercial Payer C | $1,090 | 35% of billed | n = 530 | $920 to $1,260 |
- H0015 Intensive outpatient
- H0035 Partial hospitalization
- H0018 Residential
- H0010 Detox
- H2036 Substance use treatment
- 90791 Psychiatric evaluation
- 90837 Psychotherapy
- 90834 Psychotherapy
- 90853 Group therapy
- 99214 Office visit
- Rev 0906 IOP
- Rev 0912 PHP
- Rev 1002 Residential
For years, out-of-network has been negotiated in the dark.
Out-of-network reimbursements vary from claim to claim with no clear reason. As more payers now route out-of-network claims through third-party pricers, misquoted allowables, delayed communications, and internal formulas push providers into lower-rate agreements.
And when the unpaid balance lands on the patient, the provider takes the blame. Carriers have spent years framing out-of-network billing as the problem while the amounts they allow keep shrinking. Without a number from the payer’s own side of the table, you’re negotiating against its figure instead of yours.
Clarapact puts that number in your hands.
- Payer’s allowed amount
- unknown
- Market range
- unknown
- Source you can cite
- none
- Your number
- billed charges
- Payer’s allowed amount
- $1,250 median, Commercial Payer A, H0015
- Market range
- $1,060 to $1,440 (25th to 75th percentile)
- Source you can cite
- Commercial Payer A, file version dated January 1, 2099
- Your number
- $1,250, with a citation behind it
Real allowed amounts, with a citation behind every number.
Medians and ranges by code
See the middle allowed amount for each code and the spread around it, payer by payer.
Percent of billed charges
Know how a payer’s allowed amounts compare with what was billed, so you can judge an offer in seconds.
Citations you can paste
Every figure comes with a ready-to-use sentence naming the payer and the file version, so anyone on the other side can check it.
Commercial Payer A’s allowed-amount data (file version dated January 1, 2099) shows a median out-of-network allowed amount of $1,250 for H0015, intensive outpatient, in Sample State.
One number, three conversations.
Payers
Single-case agreements and LOAs
Open the negotiation with the payer’s own allowed amounts instead of your chargemaster. Put the citation in your request so the reviewer can check it.
Third-party pricers
Repricing and reconsiderations
When a repriced claim comes back low, answer with what the same payer has allowed for the same code. Cite it in your reconsideration or appeal.
Clients
For billing companies and consultants
Use Clarapact figures and citations in the work you prepare for a client: SCA support, appeals, and negotiation packets.