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RevAllowPayer reimbursement calculators

Welcome

Choose a calculator to get started.

EAPG Facility Outpatient

Price an outpatient claim with EAPG relative weights and your contracted SIG/MED + ANC rates. CPT / ICD-10 lookup, consolidation and packaging built in.

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DRG Inpatient

Price an inpatient stay: MS-DRG base rate × CMS relative weight, plus the day-outlier per diem, with a severity-range view and death cap.

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Per-Unit Drug (NDC)

Single-drug reimbursement by NDC or J-code at your contracted per-unit rate — search your contract, pick the rate, enter units.

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Medicare Physician Fee Schedule

Look up a CPT/HCPCS code's Medicare rate (RVUs × GPCI × conversion factor) and compare it against your own chargemaster price for that code.

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Medicare APC (Hospital Outpatient)

Look up a HCPCS/CPT code's Medicare OPPS facility rate (APC relative weight × conversion factor × wage index) and compare it against your own chargemaster price for that code.

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Onboarding — upload your contract documents

Your account is being set up. Upload your executed payer contract, its exhibits, any amendments, and the fee schedule if you have one as a spreadsheet. If you have a real remittance/EOB for a claim already paid under this contract, upload that too — it lets us verify our calculator reproduces what the payer actually paid before you rely on it. One file per item — pick a category and add a note if it helps. We take it from there and confirm your rates with you before go-live.

Redact the patient name, member ID, and any other patient-identifying info before uploading — we only need the codes, dates and dollar amounts to verify pricing.
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Calculation audit trail

Every calculation you run is saved with a full, reproducible audit trail. Open one by its Calculation ID, or from the list below.

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Flagged for review

Three different signals land here, kept visually distinct — a red-bordered card means a line priced under the plan's allowable (possible lost revenue); an amber-bordered card means a charge is driving a state Medicaid outlier payment (possible overpayment exposure); a violet-bordered card means an MPFS line's diagnosis may not support medical necessity under the governing LCD (possible claim-denial / ABN exposure). Review each and mark it resolved.

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