Improve Your Claims Accuracy Today with CMSPricer’s Edit-Only Approach

Administrators of Medicare can reduce costs by eliminating manual data entry and centralizing workflows. They can also save money by re-pricing all commercial claims based on Medicare rates (Reference Basis Pricing) and rating all Medicare claims according to the Medicare cap.

Providing payers and third-party administrators with a competitive edge through a software-as-a-service (SaaS) solution, CMSPricer streamlines clinical, financial, and administrative processes. Through CMSPricer, providers can electronically transmit claims to third-party administrators (TPAs), resulting in clean, ready-to-submit claims.

Ensure Medicare Claims

TPAs find CMSPricer’s Editing option extremely useful because it allows them to tailor the output to meet their clients’ requirements by simply checking or unchecking certain parameters.

This editing service is a great way to save money on analyzing claims and identifying needed edits. Utilizing this solution will help you edit the claim without having to re-price it.

CMSPricer’s edit-only approach is typically accessed through an API interface that is both fast and scalable. The goal of this SaaS platform is to automate workflows as much as possible, while still providing users with the ability to edit and design workflows that meet their specifications. The system also provides users with analytics behind each claim and edit, so they can see how their changes impact the algorithm in production.

When clients integrate this feature, they can be confident that their claims will be paid in accordance with the latest CMS Medicare policy. This also applies to hospital claims submitted by multiple specialists for the same procedure. By avoiding overpayments and underpayments, this ensures that these claims without edits are paid according to CMS Medicare policy rate schedules.

Claims can be edited in CMSPricer in the following ways:

  • Diagnosis Code Validation
  • Local Coverage Determination (LCD)
  • National Coverage Determination (NCD)
  • Age Edits
  • Gender Edits
  • Outpatient Code Edits (IOCE)
  • Medically Unlikely Edits (MUE)
  • Correct Code Initiative (NCCI)
  • CPT Edits
  • RVU Edits
  • Modifier Edits
  • Advance Benefits Notice of Non-Coverage (ABN)

Toggle specific edits on and off as needed with CMSPricer’s edit-only feature. CMSPricer’s configuration forms provide an easy-to-use dashboard that clients can manage themselves.

You can send the client editable claims that can be self-loaded via an excel batch method, and then self-load the editable claims and send them back to the client via an easy export option. This process is unique because it is self-managed and self-served. With the system, the entire process can be completed in minutes, and the system is accessible 24/7 to meet the client’s needs and timeline.

Do you want to use CMSPricer’s editing feature? Click here to get started!