Medicare Pricing and Contract Management Solutions Made Easy

Most Accurate, Highly Secure and Lowest Cost Solutions on the Market

Why use CMSPricer to re-price and edit your Medicare claims?

No Set Up

Web-based with results returned in seconds priced at 100% of Medicare rates. Hand Key Entry or Auto Batch/EDI Uploads, Easy imports/exports. 

No Hassle

No contracts, No sales people…..pre-pay purchase with volume discounting and easy online payment processing.

Accurate

Frequent engine updates with latest CMS policies and rates to ensure accurate claims pricing. The CMS.Gov typically has a 3 month lag time and incomplete pricing results. We price all PPS types of Institutional and Professional claims including claim editing for Referenced Based pricing.

Security

No PHI or claims data stored. Utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048 bit encryption (strongest on the market). Fully HIPAA and ANSI 837 version 5010 compliant. Every user has their secure login and account. 

Availability

As long as you have access to the Internet, you can run 24/7/365 securely *excluding short windows for system maintenance.

Our Clients

We serve Payers, PPOs, TPA’s, BPO’s, Self-Funded Employers and Auditing Firms.

New Users 5 Claims FREE no commitments

NO SOFTWARE TO INSTALL

NO COMPLEX CONTRACT TO SIGN

USA OWNED AND OPERATED

100% ON-SHORE RESOURCES

ACCURATE SaaS CLAIMS PROCESSING

EASY MANUAL, BATCH OR API Claims Integration Claims ENTRY

Why our clients value us:

Our latest blog update

Save Time & Money SaaS-Based Claims Re-Pricing

How Can a SaaS-Based Medicare Claims Re-Pricing Solution Help You Save Time and Money While Preventing Overpayment? 

By pwsadmin | January 18, 2025

Amidst growing competition, more than 17 million beneficiaries – representing 31% – now opt for private payer-offered Medicare Advantage plans. Consequently, payers are vying to innovate and expand into lucrative markets.What Drives Success for Payers?To succeed, payers need the precision of an automated CMS re-pricing solution that aligns with the latest policies and rates. Manual…

Reference-Based Pricing can cut the Medicare Healthcare Costs!

Reference-Based Pricing Can Lower the Rising Cost of Medicare Healthcare Costs!

By pwsadmin | January 4, 2025

Reference-based pricing (RBP) presents a groundbreaking approach to health care reimbursements, designed to tackle the skyrocketing costs by linking claim payments to a standardized benchmark, often Medicare rates. Here’s why RBP is garnering attention: Understanding Reference-Based Pricing RBP pivots towards using Medicare rates to set payment standards. Unlike traditional PPO plans negotiating individual provider rates, RBP…

Navigating Medicare Repricing: Safeguarding Your Financial Health

Navigating Medicare Repricing: Safeguarding Your Financial Health

By pwsadmin | December 6, 2024

Effectively managing Medicare claims can be an intricate endeavor, and the intricacies of claim repricing often add to this complexity. Without proper training, these challenges can lead to significant revenue losses for organizations. Fortunately, user-friendly revenue cycle management software can streamline claim management. However, in-home care organizations must grasp the fundamentals of claim repricing with…