Expected net reimbursement (ENR) is the amount a claim is realistically expected to pay after a payer applies its contractual adjustments, which is almost always less than the provider's billed charge.
What it means
When a provider submits a claim, the billed charge is the list price, not the amount the payer has agreed to pay. Under the payer contract, that charge is reduced to an allowed amount, and after copays, deductibles, and other contractual adjustments, what actually lands is the net reimbursement. Expected net reimbursement, or ENR, is the realistic estimate of that final figure before the payer pays.
ENR is built from the practice's own history: how specific procedure codes and payer combinations have actually paid in the past. A claim billed at 300 dollars might carry an ENR of 180 dollars because that is what the contract and the practice's track record say it will collect.
Using ENR rather than the billed charge keeps the numbers honest. It reflects what the claim is genuinely worth, not an inflated list price that no payer will ever pay in full.
Why it matters for your practice
For a practice owner, ENR is the number that actually matters for planning, because it is what you will really collect once the payer is done adjusting the claim. Knowing the expected net reimbursement on your claims tells you what your receivables are truly worth and stops you from counting on billed charges that will be cut down at adjudication.
How this relates to Copay
Copay advances against the expected net reimbursement of your eligible claims, not the billed charge. ENR comes from how your claims have actually performed with your payers, which is why the amount Copay pays reflects what the claim will realistically collect rather than a list price.
See how Copay works.
Related terms
Written by Eitan Glick, CEO, Copay Inc.
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