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Medicare and Editing Solutions Made Easy

Most Accurate, Highly Secure and Lowest Cost Solutions on the Market

Why use CMSPricer to re-price and edit your Medicare claims?

No Set Up

Web-based with results returned in seconds priced at 100% of Medicare rates. Hand Key Entry or Auto Batch/EDI Uploads, Easy imports/exports. 

No Hassle

No contracts, No sales people…..pre-pay purchase with volume discounting and easy online payment processing.


Frequent engine updates with latest CMS policies and rates to ensure accurate claims pricing. The CMS.Gov typically has a 3 month lag time and incomplete pricing results. We price all PPS types of Institutional and Professional claims including claim editing for Referenced Based pricing.


No PHI or claims data stored. Utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048 bit encryption (strongest on the market). Fully HIPAA and ANSI 837 version 5010 compliant. Every user has their secure login and account. 


As long as you have access to the Internet, you can run 24/7/365 securely *excluding short windows for system maintenance.

Our Clients

We serve Payers, PPOs, TPA’s, BPO’s, Self-Funded Employers and Auditing Firms.

New Users 5 Claims FREE no commitments




EASY MANUAL, BATCH OR API Claims Integration Claims ENTRY

Why our clients value us:

“CMSPricer meets our stringent CMS Medicare claims accuracy requirements for auditing claims from over 50 Medicare Advantage plans. Using the CMSPricer SaaS based tool and interface allows us to effectively batch process with ease and precision. Great partner!”  


Our latest blog update

How to Avoid Losing Money with Medicare Repricing System

By pwsadmin | March 27, 2021

These days, employers struggle to keep up with the ever-rising healthcare costs, especially with high medical claims – how to fund them, mitigate them, and understand how they impact their plan. They face the lack of transparency issue when it comes to repricing Medicare and Medicaid costs across different health plans and networks based on…

How Medicare Claims Editing Save You from Claims Denials?

By pwsadmin | March 25, 2021

When it comes to controlling healthcare costs, and keeping employers and providers satisfied, payers play an important role. They balance these competing objectives through processing of medicare claims as efficiently and precisely as possible.  With rising healthcare and profits getting stagnant, payers need to make sure medicare claims processing is flawless. Any errors in claims…

Designed to Support TPAs For Today’s Complex Self-Funded Health Insurance Plans

By pwsadmin | January 28, 2021

Medicare claims repricing system is aimed at maximizing efficiencies through automation, enabling seamless transaction between providers, and members within employers’ self-funded plans, and delivering compliance.  Advantages of Self-funded Plans: Flexible options Portability from one stop-loss carrier to another Avoidance of most premium tasks Potential for financial gain TPAs gain significant cost-savings and ROI by swapping…