End the 3-Month Lag: How CMSPricer Delivers 100% Accurate Medicare Rates in Seconds to Save Your Firm Millions
Speed and accuracy are essential requirements that impact your bottom line in health claim processing. If you’re a Payer, TPA, Auditing Firm, or Self-Funded Employer involved in reference-based pricing, you understand the frustration of relying on outdated and incomplete Medicare data. This delay leads to costly errors, time-consuming rework, and capital tied up in misvalued claims.
It’s time to move past chasing down policy updates and wrestling with complex fee schedules.
The solution to achieving true, real time accuracy and efficiency in your operations is CMSPricer, a specialized, web based Medicare pricing and editing SaaS solution built specifically for sophisticated users like you.
The Engine Room: Why Our Accuracy is Unmatched
Our users consistently tell us that the core benefit of CMSPricer is simple: Accuracy. While the official CMS.Gov site is an essential resource, it often suffers from a significant lag time and provides fragmented data. CMSPricer’s engine is different. We perform continuous, frequent updates to ensure our solution incorporates the very latest CMS policies and rates the moment they are available. This proactive approach eliminates the industry standard three month delay, allowing you to price all Professional and Institutional claims, covering the entire spectrum of PPS types, from MS-DRG to RBRVS, with current, definitive data.
Beyond mere pricing, our comprehensive claim editing ensures your claims are not just valued correctly, but are validated against critical criteria. This includes essential checks for Diagnosis Code Validation, Local and National Coverage Determinations (LCD/NCD), and all core claim edits like Outpatient Code Edits (IOCE), Medically Unlikely Edits (MUE), and Correct Code Initiative (NCCI). This is the key to minimizing reprocessing and challenging disputes.
Efficiency and Integration on Your Terms
A powerful tool is useless if it’s cumbersome to use. That’s why CMSPricer was designed around maximum user flexibility and minimal operational overhead.
No Software to Install: Because we are a USA owned and operated, cloud based platform, there is zero software to install. You run 24/7/365 with just an internet connection, excluding only short maintenance windows.
Simple Input, Instant Results: Whether you prefer the control of hand key entry, or the efficiency of a batch run, the process is streamlined. You can easily import data from a spreadsheet, run your claim pricing instantly, and export the results back to your system in a matter of seconds.
For our technically advanced clients, the true power lies in the API Integration. In the interconnected health claim world, pricing is often just one step. Our REST API, utilizing JSON, allows your application to seamlessly submit a request for pricing and editing and receive the fully priced and edited result directly back into your environment. It turns Medicare pricing into a reliable, integrated service within your existing application, automating a process that currently consumes significant manual effort.
Security and Compliance You Can Trust
Handling health claims demands the highest standard of security. CMSPricer operates with a critical principle: No PHI or claims data is stored on our systems after processing. We utilize contemporary cloud based security, including an EV SSL Certificate, SHA2, and 2048 bit encryption—the strongest available on the market, to ensure data integrity. We are fully HIPAA and ANSI 837 version 5010 compliant, with every user benefiting from their own secure login. You get world class processing without the accompanying data storage risk.
It is time to eliminate the guesswork and start gaining back the capital and time lost to outdated processes. CMSPricer offers a pathway to 100% accurate, instant Medicare pricing, backed by robust security and zero complex contracts.
Ready to see how fast and easy batch processing can be? We have a quick demonstration of our four step process on our website.