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CLAIM ANALYTICS

Milliman Medicare Repricer

Easily compare provider payments to Medicare benchmarks

Part of the Milliman Medicare Pricers

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THE CHALLENGE

Estimating where your provider payments stand in the market is inexact and expensive

Medicare fee schedules are confusing, and local pricing variations can leave your organization guessing about competitive reimbursement rates. Without reliable benchmarks, contract managers enter negotiations with fewer insights.

THE SOLUTION

Implement software that makes it easy to accurately reprice claims

Milliman Medicare Repricer assigns Medicare-allowable fees to administrative claims data so you can surface those amounts in your enterprise data warehouse. You get service-line-level detailed claim adjudication outputs and a set of reporting workbooks for validation and reconciliation. Plus, with Milliman Medicare Repricer, you can make data-driven decisions and gain a complete picture of contract performance and opportunities.

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Milliman Medicare Repricer benefits

Optimize pricing

Quickly reveal price relationships with percentage-of-Medicare reference prices for comparison.

Translate claims data

Understand the value of services under a capitation contract by repricing data to Medicare allowed amounts.

Standardize fee schedules

Easily switch to Medicare-based fee schedules by calculating providers’ current percentages of Medicare reimbursements.

Achieve payment integrity

Verify actual payments and claims adjudication results by independently repricing claims experience to Medicare-allowed amounts.

Milliman Medicare Repricer features

Customizable outputs

Select alternative payment weights for maternity and newborns, enable extended fee schedules for non-Medicare covered services, choose the outlier pricing methodology, and price claims based on date of service or to a particular fee schedule.

Integrated groupers

Use integrated groupers for Medicare-severity diagnosis-related group (MS-DRG) and ambulatory payment classification (APC)—for accurate and efficient grouping.

Back-end analytics

Analyze large volumes of claims data to surface the information you need to make informed decisions.

Accurate data

Rely on pricing systems tested against Milliman’s full Medicare fee-for-service data feed from the Centers for Medicare and Medicaid Services (CMS).

Comprehensive data mapping

Leverage Milliman’s standard input format, code mappings, and complete provider mappings to minimize the time to value.

Milliman support

Depend on high-touch support from experts in Medicare payment and provider reimbursement.

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About the Milliman Medicare Pricers

Get an accurate pricing solution that meets your organization’s unique needs.

Looking for a cloud-based option for Medicare-based provider payments? You may be interested in the Milliman Medicare Reference Pricer.

Webinars

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Percent of Medicare caps and guarantees How it can work for you

In this webinar, we will help you understand percent of Medicare and its role in the commercial healthcare market, and provide case studies.

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Proxy pricing and Medicare pricing gaps

Our experts discuss what falls out when using Medicare fee schedules.

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Evaluating network performance: Discounts, price transparency, percent of Medicare and risk adjusted per-member per-month

In this presentation, you’ll learn about the best practices and tools available to compare networks, as well as the strengths and weaknesses of each approach.

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Related insight

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Percent of Medicare comparisons: A primer on using Medicare payment rates as benchmark

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Ask the tough questions. We’re ready for them.