3 Benefits of SaaS-Based Medicare Claims Repricing System

At times, the relationship between payers and providers turns hostile while addressing the Medicare claims from different ends of the payment continuum. Fee-for-service has been a solution, but today’s healthcare market requirements demand a more flexible approach to meet the needs of the growing Medicare enrollees from the current 35% to between 45-55% by 2025.

Which is why, the new and emerging payment models necessitate a greater collaboration between payers and providers to strengthen today’s complex healthcare environment. SaaS-Based Medicare claims repricing system is the appropriate solution to cut through the pricing complexities and build a good relationship between payers and Medicare Advantage Plan providers.

What is a SaaS-Based Solution?

SaaS stands for Software as a Service and this is a software distribution model where a third-party provider hosts applications and brings them to customers over the Internet.

With SaaS-Based model implementing to Medicare claims repricing workflow, its users who are payers, PPOs, TPAs, BPOs, self-funded employers, and auditing firms can experience a streamlined, real-time Medicare Prospective Payment System (PPS) pricing during Medicare claims repricing process. As a result of this direct PPS pricing, they can easily comply with the Centers for Medicare and Medicaid Services (CMS). The SaaS-Based Medicare claims repricing system is a solution to eliminate wasteful, manual processes that tend to drive cost and human error, ensuring peace of mind and savings in multiple areas.

How does SaaS-Based Medicare Claims Repricing System Benefit?

SaaS-Based Medicare claims repricing gives more freedom, keeps your data secure, and saves equipment and IT costs, while ensuring seamless compliance with the CMS updates.

1) Universal Accessibility:

SaaS-Based Medicare claims repricing system enables its users to log in from wherever as long as they have a valid internet connection, helping them monitor claims on-the-go and see changes occur in real-time. It offers solutions for easy to perform medical billing workflows on different types of devices, connect them to members, providers, and all essential stakeholders. With a self-service Medicare and Medicaid Solution like CMSPricer, the users can securely access eligibility, provider information, and other configurable data fields – all from their computer, tablet, or smartphone.

2) Enhanced Accuracy:

SaaS-Based solutions for Medicare claims repricing can keep up with frequent engine updates with the latest CMS policies and rates. This feature ensures accurate claims pricing. The CMS.Gov typically has a 3-month lag time and incomplete pricing results. This SaaS-Based solution can price all PPS types of Institutional and Professional claims including claim editing for Referenced Based pricing.

3) More Security:

The biggest concern is when it comes to security of the patient records. In paper-based workflow, keeping PHI data safe is a kind of myth while in digital record keeping, password is the key and, therefore, safe from any breach. The problem with these two methods is that they do not keep your records safe from other things like a fire or your computer crashing. SaaS-based Medicare claims repricing solution means keeping all of your records safe from disaster. Even if your computer crashes, the records are kept safe in the cloud and are still accessible when your computer is up and running again. See how CMSPricer guarantees no PHI (Protected Health Information) or claims data breach. It is because CMSPricer utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048-bit encryption (strongest on the market). CMSPricer is fully HIPAA and ANSI 837 version 5010 compliant, which means every user has their secure login and account.


Using a SaaS-Based Medicare claims repricing system, payers can leverage automated adjudication of rates, reduce the risk of paying claims incorrectly, and effectively batch process with ease and precision. They can also import or export a claim file for repricing so easily with a custom interface on the system. But, all these essential features may not be available with every SaaS-based Medicare claims repricing system, so make sure you check out them with those you are planning to implement.  

Do you want to know what more ways a SaaS-Based Medicare claims repricing system can streamline your process? Fix a discussion here.