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Reimbursement

A sample fee schedule for the most commonly billed procedure codes for your specialty can be obtained by calling our Service Operations department at (800) 950-7040. For your information, the reimbursement process is as follows:

  • Submit your normal charges on a standard CMS-1500 or UB92, or successor form, to the claims address on your patient's ID card.
  • The health plan will then either pay the billed charges or the MultiPlan/PHCS contracted rate, whichever is lower. MultiPlan does not pay claims.

Please note: procedure codes that do not have a specifically contracted rate are paid based on the percentage reimbursement rate specified in your network agreement. Facility outpatient claims with multiple procedure categories are paid at 100% of the highest payment category covered, and 50% of all additional covered categories. Therefore, it is important that you verify the benefit coverage with the patient's health plan for each individual procedure involved.