> ## Documentation Index
> Fetch the complete documentation index at: https://docs.pricemedic.com/llms.txt
> Use this file to discover all available pages before exploring further.

# How do Reimbursements Work?

> How contract reimbursement terms are classified and materialized

## What Is Reimbursement Classification?

Reimbursement classification breaks down payment arrangements in contracts into structured, comparable formats. It ensures consistency across payers and networks.

## Fee Schedules

Each schedule includes:

* **Title** (Specialist Rates, Primary Care Schedule)
* **Primary Methodology** (current year Medicare, fixed year Medicare, custom, payer-controlled, unknown)
* **Scope Summary** (services, providers, networks covered)
* **Effective Dates**

## Payment Methodologies

* **Current Year Medicare**: Rates tied to the current year’s schedule
* **Fixed Year Medicare**: Based on a specified past Medicare schedule
* **Custom**: Explicit dollar amounts or custom tables
* **Payer Controlled**: Determined by the payer’s internal fee schedule
* **Unknown**: Not clearly defined

## Reimbursement Sections

* Individual payment rules
* Network applicability (commercial, Medicare Advantage, Medicaid, Tricare)
* Billing codes associated with each rule

## Materialization Process

1. **Rate Calculation**
   * Medicare-based: Uses PriceMedic’s schedule builder
   * Custom: Extracted from attachments or tables
   * Payer-controlled: Linked from payer’s internal schedules

2. **Output Format**\
   Standardized tables with:
   * Billing code
   * Modifier
   * Setting (facility or non-facility)
   * Allowable amount

3. **Source Documentation**
   * Page references
   * Contract excerpts
   * Cross-references to exhibits or appendices

<Tip>
  Materialized schedules create a consistent dataset for analysis, comparison, and negotiation.
</Tip>