Percentry Allowed-Amount Percentiles · For price-file vendors and consultancies
Allowed amounts, calculated from 835 data
Every percentage or algorithm rate in a hospital's price file now needs a count of allowed amounts and the median, 10th, and 90th percentiles, all from 835 remittances. Allowed-Amount Percentiles calculates them, and shows how it got every number.
- Count, median, 10th and 90th percentiles
- JSON and CSV (tall and wide)
- Patient data stays on your network
Why so many counts come out “0”
The rule is simple to state and hard to meet. The 835s have to be narrowed to final, primary-payer payments from the 12 to 15 months before the file is posted, then matched to the file's rows by location, payer, plan, setting, and code. Plans are where most pipelines break: a price file lists plans by names that never appear in an 835.
When the matching fails, the file reports that no payments were received. In September 2026, 58% of the Georgia hospitals we reviewed that have 100 or more percentage-based rates reported a count of “0” on nine in ten of them, for services hospitals are paid for every day.
A named senior official attests that the file is true, accurate, and complete. Allowed-Amount Percentiles gives them the numbers, and the evidence behind them.
How it works
- Reads the price file to find every rate that needs allowed amounts.
- Reads 12 to 15 months of 835s and keeps only what the calculation needs: no patient names, member IDs, or account numbers.
- Cleans the payments: each claim's final adjudication, primary payer only, paid to that location, inside the lookback window, and no $0 allowed amounts, as CMS instructs.
- Suggests a payer and plan mapping from the 835's payer IDs, names, and claim filing codes. Your team confirms it.
- Matches payments to rates and calculates the count, median, 10th and 90th percentiles by CMS's rules.
- Checks the result against CMS's requirements before the file is posted.
Built for the hard parts
No zero it can't prove
Rates the tool can't evaluate, such as a plan that isn't mapped or a chargemaster-only code, are flagged for your team, not reported as “0”.
Unmatched dollars, in plain view
Payments that match no rate are totaled by payer and setting, so a mapping gap reads as, for example, “31% of BCBS outpatient dollars matched no row”, not as a file full of zeros.
Notes that say something
Where the count really is zero, the note names the payer, plan, location, and dates, instead of one canned sentence on every row.
CMS's rules, written down
Counts as “0”, “1 through 10”, or the exact number from 11 up. The next-highest amount when a percentile falls between two.
Where CMS's guidance leaves a choice, such as which date starts the lookback window, it's a setting, recorded in every run.
What you get
The fields for every rate, and the evidence the attesting official can rely on.
Open the sample evidence report
The sample is made from a made-up hospital, payers, and 835 remittances. Every run records the software version, its settings, and a fingerprint of every input file, so it can be reproduced.
- Count, median, 10th and 90th percentiles, and notes for every rate, as CSV or JSON for your pipeline
- Or the completed price file in its original format, read back and checked
- The lookback window, the files and payments read, and what was excluded and why
- The payer and plan mapping used
- Matched and unmatched dollars by payer and setting
- For each rate, how many payments were used, and from what dates
Your data stays with you
Allowed-Amount Percentiles runs as a command-line tool or container on your own servers. 835s contain patient information; they never leave your network, and Percentry never holds them. Each payment is reduced to what the calculation needs: location, payer and plan, setting, codes, service month, and allowed amount.
Percentry doesn't receive patient information, including when it supports a run.
Independent
Percentry reviews hospital price files independently, so we keep the two apart: Percentry never reviews a file whose allowed amounts were calculated with this tool.
Building price files for hospitals?
Allowed-Amount Percentiles is ready for its first pilots. Tell us how many hospitals you build files for, and where their 835s come from.