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 claims pricing accuracy and provider relationships all throughout the healthcare ecosystem.  

By leveraging the Medicare claims repricing solution, payers, PPOs, TPA’s, BPO’s, self-funded employers and auditing firms can streamline their workflows and gain significant cost-savings and ROI. Instead of continuing with the legacy claims administration systems, they can leverage the power of a SaaS-based Medicare claims repricing system like CMSPricer that can help TPAs reduce manual workloads and help achieve the competitive edge that they need for cost-saving benefit administration. 

SaaS-based Medicare repricing platforms also include responsive portal capabilities to allow all stakeholders to connect, and share data in real-time. Technology infrastructure also remains up-to-date and provides long-term value to the users while helping them win new business. 

CMSPricer’s flexible SaaS-based solution for Medicare repricing workflows can enable TPAs:

Configure Contract Claims

Payers, TPAs can now configure any contract claims at any specific rate and automate the pricing based on a predefined fee-for-service (FFS) loaded schedule. It will save you time to generate and export claim reports to providers and accelerate processes 3x faster. 

Edit Batch Pricing 

Get an edit-only solution to analyze a claim and identify if it needs any edits. Once identified, get it modified on the fly. In order to leverage this option, implement a fast and scalable API interface. Users can customize configurations to switch “on/off” specific edits, if desired. Get configuration forms available on the CMSPricer’s easy, user-friendly dashboard that the clients can self-manage. The clients can also self-load the claims for editing via an excel batch method, whereas the client imports the claims to edit and to easily export the claim results for all self-services. The entire process can be performed in a matter of minutes, thereby saving you time and money. 

Simplified Workflows

CMSPricer’s powerful EDI hub allows for hand key entry, auto batch or EDI uploads, easy imports and exports, with results returned in seconds priced at 100% of Medicare rates. 

Improved Transparency for Ever-changing Compliance Requirements

Clients can expedite growth while reducing risk through end-to-end transparency and centralized documentation. The best side of using CMSPricer is clients will stay compliant with the latest CMS policies and rates and ensure accurate claims pricing. They can price all PPS types of institutional and professional claims, including claim editing for referenced based pricing.


SaaS-based Medicare repricing system, CMSPricer can automate complex benefit calculations, and minimize the risk of paying claims incorrectly. TPAs can recover significant overpayment of claims and reduce utilization by leveraging the PC Pricer CMS SaaS-based system CMSPricer’s  real-time solutions, automated audits, responsive reporting, and much more.

Want to leverage the power of CMSPricer? CLICK HERE & Get 5 Claims FREE!