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Designed to Support TPAs For Today’s Complex Self-Funded Health Insurance Plans

Medicare claims repricing system is aimed at maximizing efficiencies through automation, enabling seamless transaction between providers, and members within employers’ self-funded plans, and delivering compliance. 

Advantages of Self-funded Plans:

  • Flexible options
  • Portability from one stop-loss carrier to another
  • Avoidance of most premium tasks
  • Potential for financial gain
  • TPAs gain significant cost-savings and ROI by swapping traditional claims and benefits systems with centralized SaaS-based medicare claims repricing systems. As a result, they streamline workflows and track providers, benefit plans and core administrative processes. 

    CMSPricer’s SaaS-based Medicare claims repricing system delivers the competitive edge that you need for cost-efficient benefit administration. This system not only helps TPAs reduce manual workloads, but it includes responsive portal capabilities to allow members, providers, and administrators to connect, communicate, and share data in real-time.

    CMSPricer self-service medicare claims repricing system is an ideal solution for TPAs, who can stay up-to-date with time-to-time CMS updates, which help them provide long-run value for their existing clients while helping them win new businesses. 

    Self-service, SaaS-based Medicare and Medicaid claims repricing system CMSPricer is scalable, agile solution for TPAs that enables them for:

    Simplify and Streamline Workflows:

    CMSPricer’s efficient EDI hub delivers essential efficiencies with end-to-end workflows for claims, encounter data, and more. 

    Improve Automation and Efficiencies: 

    CMSPricer empowers efficient time-management and automated claim editing. 

    Comply with Cost-Saving Objectives:

    CMSPricer automates complex benefit calculations to drive high auto-adjudication rates and minimizes the risk of paying claims mistakenly. 

    Configure Self-Funded Employer’s Plan:

    For companies who want to self-fund their health insurance, TPAs offer several plans based on the size of the company and that suit their requirements and budget. By using CMSPricer, TPAs can custom design health insurance plans as per the specifications of the company and also offer more than one or many medicare plans to facilitate easy and transparent selection of a plan.

    The advantage is, the self-funded employers have the potential for financial gain, resulting from a better-than-expected claims experience. 

    Advantages of Using CMSPricer:

    TPAs can reprice Medicare and Medicaid claims accurately and quickly, based on the current CMS rates by using the CMSPricer system that keeps updating the pricing rules 10-times faster than the CMS PC Pricer tool. CMSPricer users can also “batch” claims into our system easily, and import/export a claim file for re-pricing so easily with the custom interface of CMSPricer.  

    With the implementation of CMSPricer, TPAs can provide a base level of service or services, such as claims adjudication, eligibility maintenance, and so forth. They can develop wellness programs and tools to improve participant health, integrate benefit with utilization management, and provide a premier network partner and or pharmacy benefit manager for contracted. TPAs can also assist with plan design and draft summary plan descriptions to your specifications. 

    CMSPricer, a SaaS-based medicare claims repricing system, delivers powerful solutions to TPAs, empowering them with extensive control over the process of claims adjudication and resolution. CMSPricer automates repricing workflows and offers significant cost-savings with auto-adjudication and pricing of all PPS types of institutional and professional claims including claim editing for referenced based pricing.

    Highlights of CMSPricer User Advantages:

  • No installation required for being SaaS based
  • Simplify workflows for Medicare claims repricing based on Medicare claims processing manual
  • Utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048 bit encryption
  • Fully HIPAA and ANSI 837 version 5010 compliant
  • Easy manual, batch or EDI claims entry
  • Also, you can buy a CMSPricer user plan directly with “no contract” and be pricing claims in the next 15-minutes. All the more, as long as you have access to the Internet, you can run 24/7/365 securely, excluding short windows for system maintenance.

    Want to engage with a proven partner to drive your business enablement? Let’s connect with CMSPricer, serving payers, PPOs, TPA’s, BPO’s, self-funded employers and auditing firms.

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