Medicare Claims Repricing Solution for Evolving Marketplace

The Medicare Advantage program seems to be thriving. Premium growth in Medicare advantage has been far lower on average than in the marketplaces. Enrolment has continued to increase, now accounting for about one-third of Medicare enrolment.

Market Size:

In 2019, one-third (34%) of all Medicare beneficiaries, which include 22 million populations, are enrolled in Medicare Advantage plans. It indicates the potential market is still larger and highly motivated (compared to the growth rate from 19 million in 2017) to enrol in comprehensive coverage with the coordinated care, because healthcare risks tend to increase with age. This enrolee population is stable, with little switches between Medicare Advantage plans from year to year. So, the payers can see potential returns from managing their enrolees’ healthcare needs.  


With this expansion of the Medicare Advantage in the marketplace, healthcare payers who deal with Medicare and Medicaid claims pricing are increasingly challenged to optimize and modernize their core administrative processes. Their experience of using manual processes and legacy administrative systems points out to the chances of a barrage of inaccurate and costly outcomes.


Payers (TPAs, BPOs, self-funded employers, auditing firms) are increasingly getting inclined to leverage the benefits of using automated. They are now aware that Medicare claims repricing systems are the best solution they can utilize to process Medicare claims repricing tasks and achieve accurate outcomes through a desired speed. It enables them to stay compliant with the latest CMS policies and rates and reduce or eliminate duplication errors, thereby ensuring accurate claims pricing, for accelerated ROI.

Repricing System:

The comprehensive CMSPricer, a SaaS-based Medicare claims repricing system, allows its users to meet evolving standards for regulatory compliance while delivering coordinated, consistent, cost-effective care for all your Medicare and Medicaid needs.

With the continued initiative of CMS to improve their delivery models, policies and rates, and the increasing number of the aging U.S. population, the CMSPricer is maintaining the same rate of progress by expanding their SaaS-based platform with solutions to accommodate CMS initiatives and automate workflows for Medicare and Medicaid payer community. CMSPricer is aimed at empowering Medicare Advantage payers with the performance they need at significantly lower operating costs for the beneficiaries.

CMSPricer – the Highlights of User Benefits:

No Set-up Required

A SaaS-based or web-based system, CMSPricer users do not need to install it. It enables them to access it from any device, anywhere, anytime. Users can get results returned in seconds priced at 100% of Medicare rates. It also allows hand key entry or auto batch/EDI uploads, besides easy imports/exports.

100% Data Security:   

CMSPricer does not store PHI (protected healthcare information) or claims data. It utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048 bit encryption (strongest on the market) and fully HIPAA and ANSI 837 version 5010 compliant. Every user has their secure login and account.


As long as users have access to the Internet, they can run it around the corner securely, excluding short windows for system maintenance.

No Hassle:

The top advantage of using CMSPricer is you don’t have to sign up any complicated contract. In fact, the new users can get 5 claims pricing for free, which will help them get a hang of it. Based on that, they can proceed.

In Conclusion:

CMSPricer deploys mission-critical Medicare claims repricing solutions to simplify and streamline Medicare claims repricing requirements quickly and accurately. CMSPricer is a trusted and rule-based cloud technology that empowers payers to manage all aspects of Medicare and Medicaid claims repricing.  

Learn more about CMSPricer and the user advantages you can achieve by clicking here.