The ERS fee schedule was developed using a process to calculate a reasonable and
acceptable reimbursement for all medical procedures.
The process takes into account:

• Cost-to-charge ratios
• Geographic adjustments
• Medicare reimbursements
• CMS-provided statistics
• PPO contractual reimbursements
• Commercially available benchmarks
• Historically acceptable reimbursements

ERS discounts are:

• Deeper than UCR
• More favorable to the provider than Medicare or large carrier discounts
• Reasonable, resulting in greater provider acceptance and limited challenges

ERS may be used by payors in several ways:

• Instead of UCR on out-of-network claims where no contractual discount applies
• On all out-of-network claims with billed charges below a certain threshold
• In lieu of supplemental PPO networks on all out-of-network claims
• As the primary means of healthcare cost containment replacing all PPOs
• As a benchmark for supporting analysis of the effectiveness of existing contracts
  

CAI/NPPN provides repricing and back-office support for all of the processing
models described above when claims are received via EDI.

The ERS fee schedule was created by Navigant Consulting, an NYSE listed
company (NCI) with more than $1 billion market cap. Navigant Consulting employs
nearly 2,000 consultants, with over 400 consultants focused on healthcare.
Navigant has extensive experience in the development of medical fee schedules
with clients ranging from large national carriers like the Blues to state Medicaid
agencies and Medicare. To develop the ERS fee schedule, Navigant employed
proprietary logic developed over many years of experience working with large
payors. Using provider payment information from multiple sources, as well as
cost of service information available in the public domain, Navigant calculated
reasonable and fair reimbursements for all medical CPT codes and outpatient
encounters and facility-specific reimbursements for inpatient services.