Third-party administrators (TPA) can save a lot of money by centralizing their operations and automating laborious tasks. TPAs are able to price all Medicare claims in addition to re-pricing all commercial claims at Medicare rates (Reference Based Pricing) at a percentage of Medicare Allowable. SaaS-based Medicare claims repricing platform from CMSPricer streamlines clinical, financial, and administrative procedures to give TPAs and payers a competitive advantage. Cms processing manuals use one of the greatest claims processes to allow providers to communicate their medical claims to the TPAs electronically.
Benefits for businesses using CMS Pricer
The SaaS-based, scalable CMSPricer technology enables TPAs to make correct CMS Medicare rates and pricing decisions.
Automate manual tasks: CMSPricer offers a customizable gateway for members and providers to connect, share, and communicate, in addition to helping TPAs reduce manual effort.
Realize accuracy
CMSPricer updates its system with the most recent CMS policies and rates to assure accurate medical claim pricing. CMSPricer can price all PPS types of institutional and professional claims, and claims may also be amended to make sure reference-based pricing is applied. For CMSGov, incomplete pricing results and a three-month lag period are typical. CMSPricer complies with stringent CMS regulations for the accuracy of Medicare claims to audit claims from more than 50 Medicare Advantage plans. The Medicare processing manual will be simple and accurate as a result.
24/7 online accessibility
In contrast to classic medical claim processors, which have a working period inside a specific timeframe, CMSPricer allows users to access the system as long as they have Internet connectivity.
Data protection
In compliance with the EV SSL Certificate, 5HA2, and 5HA2 (the best encryption on the market), the CMS processing manual encrypts data using 2048 bits. CMS Pricer guarantees that no PHI or claims data is stored in addition to being HIPAA and ANSI 837 version 5010 compliant. Users have safe accounts and logins.

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