Payer contract guide
Official sources linked below
Negotiating with Triple-S: Fee Schedule and Reimbursement Rate Benchmarks for 2026
Triple-S Salud is Puerto Rico's largest health insurer and an independent Blue Cross Blue Shield licensee. It joined GuideWell in 2022. PayerPrice structures the published Triple-S rate records it tracks so contract teams can compare the same plan, market, and provider type.
Triple-S Salud
Puerto Rico Blue Cross Blue Shield licensee
Plans tracked
Providers (NPIs)
Rate observations
MRF publication cadence
Monthly
Last refresh
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Triple-S Overview
Triple-S Salud, at a glance
Triple-S Salud is Puerto Rico's largest health insurer and an independent Blue Cross Blue Shield licensee. It joined GuideWell in 2022.
Use Puerto Rico data for a Triple-S comparison. A mainland national average does not establish the appropriate contract rate on the island.
Payer sources
GuideWell: Triple-STriple-S reimbursement can vary by product, network, provider contract, service details, and geographic location. Match those attributes before relying on a parent-brand benchmark.
Quick Facts
OFFICIAL PAYER + PAYERPRICE DATA
| Payer Type | Puerto Rico BCBS licensee (GuideWell) |
| Total Membership | |
| Market Share | |
| Plan Types | Commercial Medicare Medicaid |
| Plans Tracked in PayerPrice | |
| Data Source | Machine Readable Files (TiC Rule) |
| Data Freshness | Updated monthly |
Negotiation Playbook
How to negotiate better Triple-S reimbursement rates
Use these four steps to check the current contract, choose comparable rates, and prepare a specific proposal for Triple-S.
Step 1
Benchmark your current rates
Start with the executed contract and recent remittances. Confirm which rates are in use before comparing them with published data.
Step 2
Prioritize material services
Use paid claims to find the services that matter most financially. The priority list should reflect your practice, not an arbitrary number of codes.
Step 3
Build a comparable peer set
Compare published rates from the same plan and market for similar providers. Use them as context; they do not prove what another provider was paid on a specific claim.
Step 4
Build the negotiation case
Show the current terms, matched benchmarks, expected financial effect, and proposed rates. Spell out any assumptions.
Build a proposal the payer can evaluate.
Match published rates to the contract's network and market, then apply your own service mix to estimate the financial effect.
See our full payer contract negotiations guide for the deep dive.
Reimbursement Rates · National Avg.
Triple-S rates for commonly billed CPT codes
These national-average in-network rates come from the latest available PayerPrice dataset. The table also shows the Medicare allowed amount for each selected CPT code. The provider contract and claim details determine the actual reimbursement.
| CPT | Description | Category | Triple-S National Avg. | Medicare Benchmark | |
|---|---|---|---|---|---|
| 99214 | Office Visit, Established (Moderate) | E&M | View rates | ||
| 99213 | Office Visit, Established (Low) | E&M | View rates | ||
| 99215 | Office Visit, Established (High) | E&M | View rates | ||
| 90837 | Psychotherapy, 60 min | Psychiatry | View rates | ||
| 90834 | Psychotherapy, 45 min | Psychiatry | View rates | ||
| 90791 | Psychiatric Diagnostic Evaluation | Psychiatry | View rates | ||
| 70450 | CT Head/Brain without Contrast | Radiology | View rates | ||
| 73721 | MRI Lower Extremity Joint | Radiology | View rates | ||
| 45378 | Diagnostic Colonoscopy | Surgery | View rates |
Rates shown are national averages. Actual Triple-S reimbursement varies by market, plan, geographic location, and provider contract. For provider-level detail by NPI or Tax ID, run a free sample report.
Triple-S Machine Readable Files
How to read Triple-S machine-readable files
Under the Transparency in Coverage requirements, most non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage must publish machine-readable files with in-network negotiated rates and out-of-network allowed amounts and billed charges. See the CMS guidance for plans and issuers. CMS's technical clarification states that the files are updated monthly.
PayerPrice makes the Triple-S records it tracks searchable by billing code, provider, plan, and market.
Search Triple-S rates without opening raw filesrate observations in latest dataset
Frequently asked
Common questions about Triple-S fee schedules
A Triple-S fee schedule sets reimbursement terms for covered services in a provider agreement. The contract may use code-based prices or another payment method. PayerPrice organizes the published Triple-S rate records it tracks for comparison.
For Triple-S contract leads
Compare published Triple-S rates for similar providers.
Start with a sample of published Triple-S rate data, then narrow the comparison by plan, market, billing code, and provider attributes.
Your sample includes
Published rate records from Triple-S
CPT and Medicare comparisons, where available
Filters for plan, market, and provider
Guidance for reading machine-readable files