Reference · rate intelligence

Healthcare Rate Intelligence Glossary

Every term Reddenda uses, defined once, in plain language. These are the words behind your RateScore, your contracted rates, and the public federal filings we build on. No PHI is involved anywhere in this glossary or in the data it describes. Ready to see yours? Run a free RateScore.

NPI: Your National Provider Identifier, the 10-digit federal ID number every provider and practice already has; it is how we look up your rates, never your patients.
CPT code: The 5-digit billing codes on the claims you send, one per service, like 99213 for an office visit.
HCPCS: The billing code set for equipment and supplies, a cousin of CPT; DME suppliers bill under it.
Payer: An insurance company or health plan that pays your claims, like Aetna or a Blue plan.
Contracted rate: The dollar amount your contract with an insurer says it pays you for a specific code.
Transparency-in-Coverage: The federal rule, in force since 2022, that makes insurers publish the prices they negotiate with every provider; those public files are our data source.
Local peer median: The middle contracted rate insurers pay practices like yours near you; it is the line we compare your rates against.
P90 target: The rate near the top of your local market, where 90 percent of nearby peers are paid at or below it; a realistic ceiling to negotiate toward.
RateScore: Our 300 to 850 score of how your contracted rates compare with local peers, like a credit score for what insurers pay you.
MSO: A management services organization, a company that runs several practice locations under one umbrella.
RCM: Revenue cycle management, the industry name for medical billing firms.
DME: Durable medical equipment, meaning braces, CPAP machines, wheelchairs, and other billable equipment and supplies; Medicare's version of the code set is called DMEPOS.
IDR: Independent Dispute Resolution, the No Surprises Act arbitration where a neutral referee picks between your price and the insurer's.
Recoupment: When an insurer demands money back on claims it already paid, often called a takeback or clawback.
Renewal window: The weeks before your payer contract auto-renews, usually the only time you can still renegotiate it.
Leverage Memo: A ready-to-send negotiation letter for one insurer, built on that insurer's own published rates, with the evidence attached.
PHI: Protected health information, meaning patient data; Reddenda never needs or sees any, because we work only from public rate files.
White-label: Our platform running under your company's name and brand.
Roll-up: Several practices or entities combined under one owner group and viewed as one portfolio.
AI Intelligence Brief: A plain-English writeup, generated from your real rate data, of what changed and what to do about it.
Fee schedule: The full list of what a payer agrees to pay you, code by code.
Medicare Fee Schedule: Medicare's public price list for every code, a baseline we compare commercial rates against.
NPI Registry: The federal government's public directory of every provider's NPI, name, and practice address.
BAA: A Business Associate Agreement, the HIPAA contract required when a vendor touches patient data; Reddenda works only from public rate files, so none is needed.
Documented reimbursement opportunity: The dollar gap we can document between your current rates and local benchmarks, modeled from public data; a negotiating target, not a guarantee of recovery.