What’s the Typical ROI for TPAs Using this Contractor Manager Claims Feature vs. Manual Medicare Repricing?

Third-Party Administrators (TPAs) handling Medicare claims know the inefficiencies of manual repricing – delays, errors, and rising operational costs. Automating the process with CMSPricer’s Contract Manager transforms workflows, delivering measurable ROI through speed, accuracy, and cost control.

The Cost of Manual Repricing

Manual Medicare repricing is time-intensive. Staff must:

1. Cross-reference contracts and fee schedules.
2. Adjust rates annually (or more frequently).
3. Handle exceptions and provider network changes.
4. Reconcile pricing errors, leading to rework.

These steps slow turnaround times and increase labor costs. For TPAs processing high claim volumes, even minor inefficiencies compound into significant expenses.

How Contract Manager Accelerates Repricing

CMSPricer’s Contract Manager automates Medicare and PPO repricing with:

1. End-to-End Contract Configuration

Set custom rates for any contract or RBP agreement.

No coding is required to apply rules by provider, service type, or date range.

2. Automated Fee Schedule Management

• Maintain multiple fee schedules (FFS, PPO) in one system.
• Dynamically adjust rates for annual updates or mid-term changes.

3. Accurate CMS Pricing & Editing

• Auto-apply Medicare rates with built-in CMS compliance.
• Edit claims in bulk to correct pricing before submission.

4. Faster Claims Processing

• Group claims by type and apply pricing rules in seconds.
• Export reports 3x faster than manual methods.

ROI: Time Savings = Cost Savings

Switching from manual repricing to Contract Manager delivers:

1. 70–80% faster processing – Eliminate hours of manual adjustments.
2. Reduced errors – Automated rules prevent costly repricing mistakes.
3. Scalability – Handle growing claim volumes without added staff.

For a TPA processing 10,000 claims/month, automation can save 40+ hours of labor, translating to thousands in annual savings.

Conclusion: Higher ROI with CMSPricer

That said, by implementing CMSPricer’s Contractor Manager, TPAs gain a measurable return on investment through reduced administrative burden, increased accuracy, and accelerated processing times. Compared to manual Medicare repricing, this automation-driven approach significantly enhances cost control and operational efficiency.

Try Contract Manager for Your TPA

Manual repricing drains resources. CMSPricer’s Contract Manager cuts processing time, boosts accuracy, and improves Medicare/PPO repricing ROI.