Medicare Pricing and Contract Management Solutions Made Easy

Medicare third-party administrators can eliminate manual data entry and centralize workflows to reduce costs. They can re-price all commercial claims based on Medicare rates (Reference Basis Pricing) and rate all Medicare claims based on the Medicare cap. CMSPricer, a software-as-a-service (SaaS) solution, offers payers and third-party administrators a competitive edge by streamlining clinical, financial, and administrative…

CMSPricer provides Medicare claims repricing information at claim line level and claims summaries based on Medicare fee-for-service (FFS) rates using a SaaS platform. In the healthcare industry, comparing medical claim allowed amounts with Medicare FFS rates is a common practice, since it provides payers with a useful benchmark to gauge their data and payment practices.…

Health plans don’t want to fix claims retroactively once they have finalized a claim. A health plan’s claim accuracy rate improves productivity, reduces errors, and is crucial to its success. To improve claim accuracy, health insurance companies need a technology that can integrate easily with all the systems in their IT ecosystem and exchange data…