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:

Our latest blog update

Emerging Considerations for Self-funded Plans and Employers

By pwsadmin | September 16, 2021

The self-funded industry has a long history of staying resilient in the face of unpredictable change. As such, the number of changes that have been required to address COVID-19 is not a shock to this sector. Now that we are in the throes of a global pandemic, the long-term consequences are only beginning to come…

Reference-Based Pricing: The Best Solution to Restrict Healthcare Spending of an Organization

By pwsadmin | September 3, 2021

Reference-based pricing has emerged as a tool self-insured organizations are utilizing to combat the growing financial burden of rising healthcare costs across the U.S. By 2022, healthcare costs are expected to rise by another 6%, largely because of rising prices. A recent study found this trend has been consistent since 2009. As a result of…

TPA Medicare Claims Repricing System Enhances Administrative Efficiencies

By pwsadmin | August 11, 2021

Third-Party Administrators gain significant cost savings by replacing manual procedures and modernizing administrative processes through centralization of their workflows. As a result, TPA’s can re-price all Commercial claims at Medicare rates (Reference Based Pricing) at a percentage of Medicare allowable as well as price all Medicare based claims.  CMSPricer’s SaaS-based Medicare claims repricing platform centralizes…