A rate card is not a document, it is a document with a date. Billing against last year’s version is not a dispute you can win, because you agreed to the current one.
What has to be recorded
| Field | Why it matters |
|---|---|
| Payer and plan | Rates differ by plan under one insurer |
| Version reference | Which notified or agreed list this is |
| Effective from | The treatment date decides the version, not the billing date |
| Effective to | Blank until superseded; set when the next version loads |
| Loaded by, loaded on | Somebody is accountable for the version in force |
| Claims priced under it | So a retrospective correction has a defined scope |
The date that governs is the treatment date
This is the detail most often got wrong. A claim for treatment in March, billed in May, is priced under the March version. A system that prices against “current” silently misprices every claim that straddles a revision.
Why the last row matters most
When a revision is discovered late, the only useful question is which claims were priced under the superseded version. Without that list the choice is between reviewing everything and reviewing nothing, and hospitals reliably choose nothing.
Questions we get asked
Which rate card version applies to a hospital claim?
The version in force on the date of treatment, not the date of billing or submission. A claim for care delivered before a revision is priced under the earlier list even if it is billed afterwards, which is why a rate card has to be stored with effective-from and effective-to dates rather than simply replaced.
How do rate card revisions cause repeat deductions?
A revision that nobody loads means every subsequent claim is priced against a superseded list, and each one is disallowed down to the agreed rate. Because the cause is identical every time, the deductions look like a payer pattern rather than a data problem, and often run for months before anyone connects them.
On the figures in this piece. Every rupee amount above is arithmetic on the assumptions stated beside it, not a market statistic. Where you need published Indian claim data with its source named, that sits on claim data. We publish no figure we cannot show the working for.