TPA Medicare Claims Repricing System Enhances Administrative Efficiencies

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 clinical, financial, and administrative processes to optimize and deliver the competitive edge that TPAs, payers call for cost-effective benefit administration. CMSPricer is a browser-based solution that facilitates the electronic transmission with one of the best medical claims processes, from the providers to deliver a clean claim ready for Medicare repricing by the TPAs. 

Benefits of Utilizing CMSPricer

The SaaS-based, and scalable CMSPricer platform consistently updates the CMS pricing rules and policies faster than the CMS.Gov PC Pricer tool and provides for accurate CMS Medicare rates as a result enabling TPAs to: 

Eliminate Manual Workloads: 

CMSPricer not only helps TPAs reduce manual workloads, but also offers responsive portal capabilities to allow the members and the providers to connect, communicate, and share data in real-time. 

Streamline Complex Batch Claims:

Users can batch claims into the CMSPricer system easily. They can experience a streamlined process of importing or exporting a claim file for re-pricing so easily with the custom interface. 

Ensure Accuracy

CMSPricer keeps its system updated to stay compliant with the latest CMS policies and rates, thereby ensuring accurate medical claims pricing. Unlike the CMS.Gov typically having a 3 month lag time and incomplete pricing results, CMSPricer is built to price all PPS types of institutional and professional claims, including the editing of claims for referenced-based pricing. CMSPricer complies with the stringent CMS Medicare claims accuracy requirements to audit claims from over 50 Medicare Advantage plans. That said you will experience ease and precision of batch processing effectively. 

Access the System 24/7

Unlike the legacy medical claims processors that have the working period in a certain time bracket, CMSPricer allows its users to have access to the system as long as they have Internet connectivity, meaning that the system runs 24/7/365 securely, excluding short windows for system maintenance.

Secure Data

CMSPricer utilizes contemporary cloud-based security and works in compliance with the EV SSL Certificate, 5HA2, and 2048 bit encryption (strongest on the market). CMSPricer is one of the best SaaS-based medical claims processors because it is fully HIPAA and ANSI 837 version 5010 compliant and secures data protection by guaranteeing no PHI or claims data is stored. That means every user has a secure login and account. 

Final Word:

Identifying and modifying Medicare claims processing issues can be a nightmare for the TPAs and their support functions. CMSPricer’s SaaS-based platform is readily accessible to customer support staff when problems arise. Users can also experience a user-friendly claim interface, allowing users to identify and correct issues rapidly and to effectively process the batch claims with ease and precision. 

The SaaS-based CMSPricer is perfectly designed to serve TPAs, payers, PPOs, BPO’s, self-funded employers, and auditing firms. Also, anybody can buy directly with no contract and be pricing claims in the next 15 minutes unlike other solution providers making you complete a contract. Get the full details.