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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

Empowering Employers & Increasing Value For Self-funded Clients

By pwsadmin | January 21, 2021

Employers who choose to offer health insurance benefits to their employees have two options for paying or funding those benefits. Those two funding arrangements are self-funded benefits and partially self-funded benefits.  Self-funded Arrangement: In the self-funded benefits arrangement, the employers guided by third party administrators (TPAs) creates, defines, and establishes a benefit plan for their…

Self-funded Employers are Leveraging Medicare Claims Repricing Tool to Cut Costs, Not Benefits

By pwsadmin | December 24, 2020

As the world deals with the impact of COVID-19, one of the most common issues we hear about healthcare today is the cost. The various healthcare studies indicate that the cost of providing medical and pharmacy benefits will rise 5 percent more for three consecutive years.  As a result, the companies that use the best-in-class…

What is Medicare Claims Repricing? Is Medicare Claims Repricing So Hard Anymore?

By pwsadmin | December 22, 2020

Medicare and Medicaid repricing system enables healthcare payers to efficiently manage healthcare provider data and automate claims pricing by leveraging its adaptive, rules-driven architecture. Medicare claims repricing can significantly lower, pre-negotiated rates which providers in the healthcare networks have already agreed. What is Medicare Claims Repricing?  Medicare claims repricing is the application of the contract…