Enhance Administrative Efficiency with TPA Medicare Claims Repricing

With the centralization of their workflows, third-party administrators can save significant amounts by replacing manual procedures with automated ones. So, TPAs can re-price all commercial claims at Medicare rates (Reference Based Pricing) at a percentage of Medicare allowable, as well as price all Medicare claims.

SaaS-based CMSPricer’s Medicare claims repricing platform optimizes clinical, financial, and administrative processes to provide a competitive edge for TPAs and payers. Using CMSPricer, providers can electronically transmit their medical claims to the TPAs using one of the best claims processes.

Medicare Claims Repricing

CMSPricer: Benefits for Businesses

With CMSPricer, TPAs are able to make accurate CMS Medicare rates and pricing decisions as a result of the SaaS-based, scalable platform.

Automate manual tasks:

In addition to helping TPAs reduce manual work, CMSPricer also offers a responsive portal for members and providers to communicate, share, and connect.

Improve the efficiency of complex batch claims

CMSPricer allows users to batch enter claims easily. With the custom interface, users can import or export claim files for re-pricing so easily.

Achieve accuracy

In order to ensure accurate medical claims pricing, CMSPricer keeps its system up-to-date with the latest CMS policies and rates. CMSPricer is capable of pricing all PPS types of institutional and professional claims, including editing of claims to ensure referenced-based pricing is applied. CMSGov typically has a 3 month lag time and incomplete pricing results. To audit claims from over 50 Medicare Advantage plans, CMSPricer complies with strict CMS Medicare claims accuracy requirements. As a result, batch processing will be easy and precise.

24/7 online access

CMSPricer allows users to access the system as long as they have Internet connectivity, as opposed to legacy medical claim processors that have a working period within a certain timeframe. Therefore, the system is available 24/7/365, with the exception of short maintenance windows.

Data security

CMSPricer encrypts data using 2048 bits in accordance with the EV SSL Certificate, 5HA2, and 5HA2 (the strongest encryption on the market). In addition to being HIPAA and ANSI 837 version 5010 compliant, CMSPricer ensures data protection by guaranteeing no PHI or claims data is stored. Users have secure logins and accounts.

In Summary:

TPAs and their support functions often have trouble identifying and modifying Medicare claims processing issues. When problems arise with CMSPricer’s SaaS-based platform, customer support staff has easy access to it. Additionally, users will experience a user-friendly claim interface, allowing them to identify issues and correct them promptly, as well as process batch claims efficiently.

TPAs, payers, PPOs, BPOs, self-funded employers, and auditing firms can all benefit from CMSPricer’s SaaS platform. Unlike other solution providers, who require you to sign a contract first, you can buy directly and start pricing claims within 15 minutes. Click here for more information.