Finally, a Solution for Complex Contract Claims: The CMSPricer Contract Manager

For Payers, PPOs, TPAs, BPOs, Self-Funded Employers, and Auditing Firms, the task of pricing claims at specific, predetermined rates has long been a source of administrative headache. You’re not just dealing with Medicare’s complex fee schedules; you’re also juggling multiple, unique contracts, each with its own set of rules, provider networks, and rate increases. The manual effort required to manage this can be immense, leading to costly errors, delays, and a significant drain on resources.

But what if you could automate this entire process, ensuring every claim is priced accurately and efficiently, every single time?

Enter the CMSPricer Contract Manager, a powerful, fully integrated tool designed to make claims at any specific rate a breeze. This isn’t just another feature; it’s an end-to-end solution that takes the complexity out of contract-based repricing, saving you time and giving you the cost control leverage you need.

A Step-by-Step Path to Effortless Automation

The beauty of the CMSPricer Contract Manager lies in its streamlined, five-step workflow. It turns a painstaking manual process into a simple, automated sequence that can accelerate your operations by as much as three times.

1. Enter Your Contract Information. The process begins with you. You simply load your contract or Reference Based Pricing (RBP) information and the associated rates into the system. This centralizes all your fee schedules and networks, eliminating the need to hunt down individual documents.

2. Review the Rules. Once the data is loaded, the platform allows you to quickly and easily review the rules you’ve entered. This step is crucial for ensuring everything is configured correctly before processing, giving you complete confidence in the results.

3. Setup Your Sophisticated Rule-Based Sets. This is where the Contract Manager truly shines. You can create advanced, rule-based configurations tailored to your exact requirements. Whether you need to apply different settings for specific providers, individual services, or within a particular date range, the system can be configured to meet your needs precisely.

4. Automate Your Pricing. With your rules in place, the system takes over. It compiles claims by type and automatically applies the parameters based on your specific contract requirements. This ensures that every claim is priced according to your unique fee schedule, all while leveraging CMSPricer’s robust, updated engine for accurate CMS pricing and editing.

5. Manage Non-Medicare Claims. What about claims that aren’t Medicare? No problem. The Contract Manager works in perfect harmony with CMSPricer’s Fee-For-Service (FFS) module. You can manage multiple fee schedules for FFS or PPO networks, and the system intelligently selects the correct schedule, even as providers change networks over time.

The Foundational Benefits of the CMSPricer Platform

This powerful Contract Manager module is built on the same foundation that makes CMSPricer a market leader. It’s a web-based, SaaS solution that delivers results in seconds. You get the most accurate, highly secure, and lowest-cost solution available without being locked into contracts or dealing with sales people.

You own your data, with no PHI or claims data stored on the platform. The system uses contemporary cloud security, including 2048-bit encryption, to ensure your information is protected and fully HIPAA compliant. It’s available 24/7/365, so you can work on your terms, and with frequent engine updates, you’ll always have the latest CMS policies and rates—without waiting for the typical three-month lag from government sites.

By combining the power of the core CMSPricer repricing engine with the flexibility and control of the Contract Manager module, you get an unparalleled solution for managing all your claims, accelerating your processes, and ensuring total financial accuracy.