| Many podiatry practices assume that because multiple Blue Cross (and other private payer) plans are submitted electronically using the same payer ID, they reimburse similarly. In reality, that assumption can cost your practice significantly each year.
Using Blue Cross as our main example: A single payer ID may represent dozens—or even hundreds—of different employer groups, PPOs, HMOs, Marketplace plans, Medicare Advantage products, and BlueCard members from other states. While claims may all flow through the same electronic payer, the contracted allowable for common CPT codes such as 99213, 11721, 11055, 20550, or L3000 can vary significantly depending on the patient’s specific benefit plan and network.
Payer IDs are primarily used to route electronic claims and do not guarantee identical reimbursement across all products.
What you should do instead:
- Track your actual allowed amounts by payer + specific plan (not just payer ID)
- Create a reimbursement comparison spreadsheet for your top 30 CPT codes.
- Review trends quarterly to identify underpayments, contract issues, or reimbursement reductions.
- Use this information when attempting to negotiate contracts and educating your billing staff.
Bottom line: If you’re only comparing reimbursement by payer ID, you’re likely overlooking meaningful differences in what your practice is actually being paid.
This topic is especially valuable because many practices have no idea that their clearinghouse may be sending claims from dozens of different Blue Cross products through a single electronic payer ID. By analyzing payments at the plan level rather than the payer ID level, practices gain a much clearer understanding of reimbursement performance and can identify opportunities to improve revenue.
Example comparison and instructions: |
