Emerging Considerations for Self-funded Plans and Employers

The self-funded industry has a long history of staying resilient in the face of unpredictable change. As such, the number of changes that have been required to address COVID-19 is not a shock to this sector. Now that we are in the throes of a global pandemic, the long-term consequences are only beginning to come…

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TPA Medicare Claims Repricing System Enhances Administrative Efficiencies

Third-Party Administrators gain significant cost savings by replacing manual procedures and modernizing administrative processes through centralization of their workflows. As a result, TPA’s can re-price all Commercial claims at Medicare rates (Reference Based Pricing) at a percentage of Medicare allowable as well as price all Medicare based claims.  CMSPricer’s SaaS-based Medicare claims repricing platform centralizes…

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CMSPricer Solution Can Reduce Claims Overpayment

he CMS PC Pricer tool used to estimate Medicare PPS payments. By using the PPS framework implemented into Medicare repricing systems, the TPAs, employers, or audit firms can manage the most complex Medicare repricing solutions.   Medicare repricing systems can automate the process of accurate editing, grouping, and pricing across multiple care settings. It enhances Medicare…

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Medicare Claims Automation at Scale: Top 4 Benefits for Payers

Behind-the-scene machinations of Medicare claims procedures are now much more complex than those days when Medicare claims automation tools came on board. Today’s procedures are often so complicated that they tend to take a couple of weeks or even more due to the streamlining and standardization of critical processes such as claims repricing.  Thanks to…

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Empower Your Medicare Advantage Claims Repricing Business with CMSPricer

In order to sail your Medicare Advantage claims repricing processes through this current Medicare environment, you need a reliable system that can empower you with the right solutions to carry out the tasks efficiently. And for Medicare claims repricing, in particular, you need a customizable platform that allows automation processes and guarantees regulatory compliance through…

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Adopt Reference-Based Pricing Model to Contain Your Company’s Healthcare Costs

Employers can anticipate healthcare expenses once they adopt the reference-based pricing (RBP) model. With its implementation, they can determine reimbursements ahead of time, select the prices they are willing to pay for a healthcare service. RBP model saves employers from surprise healthcare expenses for their employees within their company.  RBP can result in up to…

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How to Avoid Losing Money with Medicare Repricing System

These days, employers struggle to keep up with the ever-rising healthcare costs, especially with high medical claims – how to fund them, mitigate them, and understand how they impact their plan. They face the lack of transparency issue when it comes to repricing Medicare and Medicaid costs across different health plans and networks based on…

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How Medicare Claims Editing Save You from Claims Denials?

When it comes to controlling healthcare costs, and keeping employers and providers satisfied, payers play an important role. They balance these competing objectives through processing of medicare claims as efficiently and precisely as possible.  With rising healthcare and profits getting stagnant, payers need to make sure medicare claims processing is flawless. Any errors in claims…

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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…

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Empowering Employers & Increasing Value For Self-funded Clients

Employers who choose to offer health insurance benefits to their employees have two options for paying or funding those benefits. Those two funding arrangements are self-funded benefits and partially self-funded benefits.  Self-funded Arrangement: In the self-funded benefits arrangement, the employers guided by third party administrators (TPAs) creates, defines, and establishes a benefit plan for their…

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What is Medicare Claims Repricing? Is Medicare Claims Repricing So Hard Anymore?

Medicare and Medicaid repricing system enables healthcare payers to efficiently manage healthcare provider data and automate claims pricing by leveraging its adaptive, rules-driven architecture. Medicare claims repricing can significantly lower, pre-negotiated rates which providers in the healthcare networks have already agreed. What is Medicare Claims Repricing?  Medicare claims repricing is the application of the contract…

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Referenced Based Pricing: A Solution for Employers to Cut Health Plan Costs

Reference based pricing strategy in healthcare is revolutionary. It helps both employers and employees save money by paying reduced aggregate amounts based on a percentage of what Medicare reimburses these providers. It’s truly helpful for them to bend healthcare costs downward.  Let’s Explain the Benefits of Reference Based Pricing Strategy.  With the reference based pricing…

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Value Based Healthcare

The state of US healthcare concerns us all. The rising costs are the principal concern and many of us wonder why do we spend more than other industrialized nations.  Leaving aside the assertion that the “other industrialized nations” provide the same level of care, the rising costs are definitely a problem.  Many “sophisticated” schemes were…

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3 Ways Our Software Can Streamline Your Medicare Claims Repricing

Any business that handles Medicare and Medicaid claims repricing regularly knows the pain, the labor, and the enormous time the task tends to take. Ensuring that those who are involved with the task have up-to-date and accurate information and that every person knows what needs to be done next. It is especially true for those…

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