Leverage OS · Contract renegotiation
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Live toolAnthem Blue Cross of California · Provider Network Management
Re: 2027 Renewal · Sunrise Demo PT · TIN 88-2104XXX
Across our top 5 highest-volume CPT codes, our 2026 contracted rates are running 9.2% below the Anthem CA in-network market rate, weighted by volume. Source: Anthem CA TiC MRF effective 2026-04-01.
…full memo with code-by-code Exhibit A, volume tier evidence, geographic moat, systematic-underpayment evidence from Reclaim OS.
Contracts on watch
Past wins
- BCBS CA · 2026 renewal +8.4% · $84K
- Cigna · 2025 renewal +6.1% · $41K
Anthem CA · code-by-code analysis
Bargaining position
- Volume tier: Tier 2 — preferred · 22,140 visits/yr (top 8% of CA PT contracts)
- Quality scores: 96.4% clean-claim · readmission below network avg
- Geographic moat: 3 of 4 PT clinics in 95818 zip are owned by the practice
- Systematic underpayment evidence: $5,124 / 90d from Reclaim OS
2840 Riverside Blvd · Sacramento, CA 95818
NPI 1234567893 · TIN 88-2104XXX
Re: Anthem CA Provider Agreement
Renewal effective Jan 1, 2027
Anthem Blue Cross of California
Provider Network Management
21555 Oxnard Street · Woodland Hills, CA 91367
Re: Rate Adjustment Request — 2027 Renewal · Sunrise Demo PT
Network Manager,
Sunrise Demo Physical Therapy is preparing for the December 31, 2026 renewal of our Anthem Blue Cross of California Provider Agreement. This memo summarizes the rate analysis our practice has compiled in advance of that conversation.
Across our top 6 highest-volume CPT codes, our 2026 contracted rates are running 9.2% below the Anthem CA in-network market rate for the State of California, weighted by visit volume. The variance is consistent (not a single outlier) and represents an estimated $187,400 in annual revenue relative to median in-network rates for comparable contracted PT practices in our region.
The market data referenced above is drawn from Anthem Blue Cross of California's Transparency in Coverage machine-readable file, effective April 1, 2026, the same file Anthem publishes monthly under 45 CFR §147.211. For the highest-volume code on our schedule — CPT 97110 (therapeutic exercises) — our current allowed rate is $84.20 per unit, while the published in-network median rate in California is $94.20 per unit. A code-by-code comparison table is attached as Exhibit A.
Sunrise Demo PT is a Tier 2 preferred PT contract, with a 96.4% clean-claim rate, readmission rates below the Anthem-CA PT network average, and concentrated geographic coverage in Sacramento County. We're proposing rate alignment to the Anthem CA in-network median across the 23 affected codes, effective at renewal.
I'd welcome 30 minutes to walk you through the analysis. Please let me know what's possible.
Respectfully,
Practice Administrator · Sunrise Demo PT
contracts@sunrise-demo.example · (916) 555-0123