Contents
Before You Start
Open the Reimbursement View
See the Contracted (In-Network) Rates
Switch Between In-Network and Out-of-Network
Compare Across States
Calculate the EIV and Assign It to the Opportunity
When No Contract Exists
Frequently Asked Questions
1. Before You Start
You will need:
A VOB open in the iVerify module (or an Instant VOB run from an Opportunity).
An active contract for the facility and the selected payer, entered in Contracts Management with rates filled in per level of care.
Permission to view the Policy Reimbursement History section (this is role-based — the same access you already need to see reimbursement figures).
💡 How it turns on: Automatically. There is no setting. If the facility holds an active contract with the VOB's payer, the calculator detects it and shows the contracted rates by default. If there's no matching contract, the calculator behaves exactly as before.
💡 Tip: If you expect contracted rates but don't see them, confirm the contract in Contracts Management is Active, has the same payer as the VOB, and has a rate entered for each level of care. A contract with no rates will not switch the view to in-network.
2. Open the Reimbursement View
Open the VOB and go to the Policy Reimbursement History section.
Choose a time-period tab — Last 12 Months, All Time, or a specific year. The reimbursement table loads for that period.
3. See the Contracted (In-Network) Rates
When an active contract is found, the table shows a single Contracted Rate column with the contracted in-network rate for each level of care by default, and a green Contracted (INN) badge confirms in network rates are in use.
What you see | Meaning |
Contracted (INN) badge | The rates shown are the facility's contracted in-network rates. |
Contracted Rate column | The single rate from the contract for that level of care (contracted rates don't have minimum/maximum ranges). |
A level of care marked OON | That level of care is not covered by the contract, so the standard out-of-network rate is shown for it instead. |
4. Switch Between In-Network and Out-of-Network
Use the INN / OON selector above the table to switch views. No page reload — the rates update in place.
Control | What it does |
INN (Contracted) | Shows the facility's contracted in-network rate per level of care (green badge, single rate column). |
OON (Standard) | Shows the standard out-of-network rates by state, with Maximum / Avg / Minimum (neutral badge). |
💡 Tip: The contracted (in-network) rates are the same regardless of state, because they come from the contract. The out-of-network rates change by state and time period.
5. Compare Across States
While viewing the out-of-network rates, use Check another state to see the standard rates for a different state. The contracted in-network rates stay the same when you switch back to the in-network view.
6. Calculate the EIV and Assign It to the Opportunity
Click Calculate EIV.
Select a treatment template.
The Expected Insurance Value is calculated from whichever rate view is active — contracted (in network) or standard (out-of-network).
Click Assign Treatment Plan to Opportunity to save the plan on the Opportunity. This also copies the calculated EIV onto the Opportunity's Expected Insurance Value field.
⚠️ Important: If the Opportunity already has a treatment plan that this template does not continue (the plans don't line up level-of-care to level-of-care), you'll be asked: "Replace the existing plan with this template and its EIV?" Choose Yes to replace the old plan with the new one, or No to keep the existing plan unchanged.
💡 Tip: Switching the INN/OON selector after you calculate re-computes the Expected Insurance Value using the newly selected rates, so you can compare both outcomes before assigning.
7. When No Contract Exists
If the selected payer has no active contract with the facility, the calculator works exactly as it always has:
Only the standard out-of-network rates are shown.
There is no INN/OON selector and no Contracted (INN) badge.
The Expected Insurance Value is calculated from the standard rates.
8. Frequently Asked Questions
Q: Do I have to turn anything on to see in-network rates? No. Detection is automatic. If an active contract with the payer exists, the contracted rates appear by default.
Q: Why do I still see out-of-network rates for a patient whose facility has a contract? Check that the contract is Active, is for the same payer as the VOB, and has a rate entered for the relevant level of care. Levels of care not covered by the contract fall back to the out-of-network rate and are marked OON.
Q: Why does the in-network view show only one rate column? A contract sets one fixed rate per level of care, so there is no minimum/maximum range to show. The out-of-network view keeps its Maximum / Avg / Minimum columns because those come from claims history.
Q: The in-network rates look the same on every time-period tab — is that a bug? No. Contracted rates come from the contract and do not change by time period or state. Only the out-of-network rates vary by period and state.
Q: What happens when I click "Assign Treatment Plan to Opportunity"? The template's plan is saved on the Opportunity and the calculated EIV is copied to the Opportunity's Expected Insurance Value field. If a conflicting plan already exists, you'll be asked whether to replace it first — nothing is replaced without your confirmation.
Q: One level of care shows "OON" in the in-network view. Why? That level of care is not included in the contract, so the calculator shows the standard out-of-network rate for it and marks it, rather than leaving it blank.
Need Help?
If you run into issues:
Confirm the contract in Contracts Management is Active, matches the payer, and has per–level-of care rates.
Reload the VOB and re-open the Policy Reimbursement History section.
Contact Dazos support with the VOB and payer details and reference CRM-3266.