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Edit-Only Approach in CMSPricer Prevents Overpayments & Underpayments While Ensuring Claim Accuracy
By replacing manual processes and centralizing their workflows, third-party administrators can save money by reducing costs. In turn, TPAs can re-price all commercial claims at Medicare rates (Reference Basis Pricing) and rate all Medicare claims based on the Medicare cap. SaaS-based Medicare claims repricing platform CMSPricer centralized clinical, financial, and administrative processes to provide TPAs, payers…
What is the Big Deal About Reference Based Pricing?
With so many insurance options available today, it can be difficult to select the right policy. A fully insured health plan versus an employer-funded health plan is one of the biggest decisions you will have to make as an employer. Traditionally, companies pay premiums to their insurance companies for fully insured plans. Employers who operate…
Emerging Considerations for Self-funded Plans and Employers
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…