Finding fee schedules and real-time claims estimators for payers

Fee Schedules

Medicare fee schedule: how to create your own

State-run Medicaid fee schedules:  Alabama  – AlaskaArizona – ArkansasCaliforniaColoradoConnecticut – DelawareDCFloridaGeorgiaHawaii – IdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaine – Maryland Massachusetts – MichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew Hampshire – New Jersey – New MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahoma OregonPennsylvania – Rhode IslandSouth CarolinaSouth DakotaTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Tennessee has no state-run Medicaid plan.

Also compare KFF’s Medicaid-to-Medicare fee index by state

Real Time Claims Estimators

Real-time claims estimators: Cigna

  • CignaForHCP > Patients
  • Enter patient information.
  • Click Estimate Costs.

Real-time claims estimators: Aetna, Cigna, Humana, local BCBS  plans (BCBS AR, FL, IL, KS, MS, NM, OK, SC, TN, TX and Highmark):

  • Availity > Patient Registration > Eligibility & Benefits Inquiry
  • Select payer from the dropdown.
  • Enter patient information.
  • Click Patient Care Estimator.

Real-time claims estimators: United plans:

  • UHCProvider > Link > United Healthcare Claim Estimator
  • Click Pre-Determination of Benefits > Agree
  • Confirm provider information > Continue
  • Enter patient information.