CLAIM PRICING

Milliman Medicare Reference Pricer

Medicare pricing on demand

The challenge

Implementing Medicare pricing is costly and resource intensive

You need a pricing solution that meets provider contract requirements, but Medicare’s patchwork of fee schedules and groupers are complicated, and may not be appropriate for all scenarios. This can lead to delayed updates and the inability to trace pricing results back to current Medicare policies, costing additional resources and time.

The solution

Leverage flexible and up-to-date claim pricing

The Medicare Reference Pricer provides complete and up-to-date Medicare payments with the flexibility to extend Medicare to commercial and individual claim pricing. Now, you can easily adjust payment components and relativities, as well as extend pricing to non-Medicare covered services and percent of Medicare reimbursement provisions. The software can be deployed as a web service or as a batch process, and is integrated into the web-based claims examiner support system.

BENEFITS

Milliman Medicare Reference Pricer benefits

Model risks accurately

Translate climate risks into specific impacts that can be used in financial modelling such as Own Risk and Solvency Assessments (ORSA) and business planning processes.

Simplify insight

Access a dashboard of current and potential future risks, which can be combined into a single index to be tracked over time and translated into a medical inflation impact.

Segment customers

Drill down to the level of disease group and examine the effects of climate change on existing and future customer populations.

Stay current

Receive timely updates with the latest information from Centers for Medicare and Medicaid Services (CMS) to keep payment systems up to date.

Customize configuration

Choose the payment systems and components that are relevant to your network contracts and providers.

Achieve a transparent cost network

Reap the benefits of standardized payment structures and processes, including easy to understand provider reimbursement relationships and reduced administrative costs.

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FEATURES