All the rates for all service items associated with a contract can be viewed on this page. This section defines how each service is billed under a contract — in other words, this is where you tell the system what to charge, how to charge it, and under which professional role. Everything configured here pulls directly into authorizations, scheduling safeguards, and billing. If rates are not configured correctly, claims will not reflect accurate financial data, so it's important to build this section carefully and make sure it aligns exactly with your contracted fee schedule.
Adding and Updating Rates
To add a new rate, click the Add Rate button. The fields below will appear — work through them top to bottom, and confirm that the service, role, modifier, and location combinations match your contracted fee schedule before saving.
⚠️ Important: Rates must be fully configured before creating patient authorizations. Authorizations pull financial data directly from this section. If rates change after authorizations have been built, you may need to rebuild those authorizations.
Service Item
Select the service item from the dropdown. These services pull directly from your Service Inventory in the Admin module. If a service is missing here, it has not been built in Admin — the system will only allow you to bill services that have been formally configured.
Start Date & End Date
Enter the Start Date, which should align with either the contract effective date or the start date of a specific fee schedule. If applicable, enter an End or Renewal Date to ensure historical accuracy if rates change over time.
State & Office
By default, this is set to All States and All Offices. If this rate applies only to a specific state or office, narrow it here. Authorizations and scheduling will reference these selections when determining which rate applies.
Fee Type & Max Units
Select your Fee Type — for example, 15-minute units, 30-minute units, per session, or one-time fee. If your payer has a daily maximum or MUE (Medically Unlikely Edit), enter it in the Max Units Daily field. When entered, this limit flows into authorizations and scheduling to prevent over-utilization.
Billing Rate & Contracted Rate
Billing Rate — Enter your standard rate for this service, applied consistently across all patients and funding sources. This rate is used to calculate the claim total listed on your claim form and file.
Contracted Rate — Enter the reimbursement rate as agreed upon with the funder. The system uses this for reporting and revenue comparison.
Understanding the Difference Between Billed and Contracted Rates
It's helpful to understand why these two rates exist and why both matter for your organization's financial health.
Your billed rate represents the full value your organization places on a service — before any payer adjustments or contractual discounts are applied. It should be applied consistently across all patients, services, and funding types. Keeping this rate accurate protects your organization in a few important ways:
It protects you if a payer changes their rate. If your billed rate is lower than your contracted rate, a payer will simply pay you at the lower billed amount — without flagging it as an error. They won't assume it was a mistake; they'll treat it as what you asked for. Billing at or above your contracted rate ensures you're never accidentally leaving money on the table if a payer quietly increases their reimbursement.
It gives you data to negotiate with. Having an accurate billed rate creates a clear record of the gap between what your services are worth and what you're being reimbursed. This data is valuable when it comes time to renegotiate your contracted rates with a payer.
It supports fair reimbursement across your region. When an organization bills below the industry standard, it can signal to payers that the lower rate is acceptable — not just for that organization, but for others in the same region. Billing at your true standard rate helps maintain appropriate reimbursement levels across the board.
Your contracted rate is the negotiated amount you have agreed to accept from a specific payer. While your organization may value a service at $100, your contracted rate with a particular payer might only be $60. That gap is the contract allowance — the amount the payer will not reimburse. The system uses the contracted rate for reporting and revenue comparison, and your Expected amount in Collections is calculated based on this rate. If it's entered incorrectly, your financial reports will be off.
Role
Select the role this rate applies to — BCBA, RBT, SLP, etc. If a role is missing, it must be configured in Admin under Roles & Clearance. Note that when a bill is generated, the system will bill based on the provider's highest credentials. The order of credentials can be set under Admin > Roles.
Place of Service
Select where the service is rendered. If rates do not vary by location type, select all applicable options. If your contract reimburses differently for telehealth versus in-home services, split those into separate rate lines.
Day/Time of Service
If your contract reimburses differently based on evenings or weekends, configure that here. If not, select all options.
Modifiers
Add any required modifiers here. All modifiers entered on a single row will apply together. Keep the following in mind:
If a modifier applies only to one role or one location type, split it into a separate rate line.
If the system is unable to identify a modifier based on role, place of service, or time of service (e.g., patient present vs. not present), add each variation as a separate code under Admin > Service Inventory and enter it as a separate line in Rates & Modifiers.
Once you've confirmed everything is correct, click Add Rate to save.
Common Mistakes to Avoid
Taking a few extra minutes to configure rates correctly prevents downstream billing corrections. Here are the most common mistakes to watch out for:
Not splitting lines when required. If reimbursement differs by role, telehealth vs. in-home, or weekday vs. weekend, those must be separate rate lines. Combining them will produce incorrect claims.
Forgetting to enter Max Units Daily when the payer has a cap. If this isn't configured, the system cannot prevent over-scheduling, which can lead to claim denials.
Mismatching the Fee Type to the contract. If the payer reimburses per 15-minute unit but the rate is built per session, billing will not calculate correctly.
Entering rates before Service Inventory is finalized. If service types — especially group designations — were not set up correctly in Admin, rate behavior and payroll reporting can become inconsistent.
Building authorizations before rates are complete. Authorizations pull financial data directly from this section. If rates change later, you may need to rebuild those authorizations.
Have questions about rates and modifiers? Reach out to our support team — we're happy to help! 💙