Client: Advantage PHC
Industry: Healthcare
Situation
As a healthcare advocacy company focused on reducing costs and improving transparency, APHC launched their repricing service in October 2023 to help clients control escalating claims expenses. Rapid growth in demand caused their claim volume to double from 54 to over 200 per day within five months.
Challenge
APHC’s manual repricing couldn’t keep up with rapidly growing claim volumes. Reliant on faxed claims and spreadsheets, delays in producing timely Explanation of Benefits (EOBs) caused payment slowdowns and frustrated providers. APHC needed an automated, scalable repricing solution to scale with customer need.
Solution
The Milliman team implemented MRPricer to automate APHC’s repricing using live claim data, replacing manual faxing and spreadsheets. MRPricer’s integrated web portal allowed APHC to submit claims electronically, cutting manual tasks and accelerating EOB generation. This enabled APHC to efficiently handle growing claim volumes and improve provider communication.