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CLAIM PRICING

Milliman Medicare Reference Pricer

Medicare pricing on demand
Part of the Milliman Medicare Pricers

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THE CHALLENGE

Implementing and maintaining Medicare pricing is costly and resource intensive

Medicare’s patchwork of fee schedules and groupers is complicated. This can make it difficult 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 pricing to commercial and individual claim pricing. Now, you can easily adjust payment components and extend pricing to non-Medicare covered services and percent of Medicare reimbursement. Plus, the software can seamlessly integrate with your system as a web service or as a batch process.

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About the Milliman Medicare Pricers

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

Looking for an option that can be installed locally? You may be interested in the Milliman Medicare Repricer.

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Milliman Medicare Reference Pricer benefits

Reduce costs

Avoid overpayment and inaccurate claims pricing.

Standardize payment using Medicare

Simplify contract negotiations for individual, commercial, and Medicare Advantage with the flexibility needed to capture contract nuances.

Ensure Pricing Accuracy

The Medicare Reference Pricer is updated automatically and applies appropriate fee schedules and adjustments based on the claim service date, reflecting the latest rates of the Centers for Medicare and Medicaid Services (CMS).

Stay current

Receive timely updates with the latest information from CMS, so payment systems are always 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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Milliman Medicare Reference Pricer features

Live claim pricing

Adjudicate medical claims quickly using Medicare fee-for-service payment methodologies.


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Flexible integration

Use Medicare Reference Pricer from your web browser, or seamlessly integrate it with your current claims system.

Customizable data

Select alternative payment weights for maternity and newborns, enable extended fee schedules for non-Medicare covered services, choose outlier pricing methodology, and set your own fee schedule update calendar.

Integrated groupers

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

Accurate output data

Rely on pricing systems tested against Milliman’s full Medicare fee-for-service data feed from CMS.

Milliman support

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

Client case study

See how Milliman Medicare Reference Pricer is helping businesses nationally

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CLIENT CASE STUDY

A tight deadline and cost-saving solution

Agrace not only saved thousands of dollars but gained a more comprehensive tool than their previous vendor.

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Client case study

Manual to modern: Repricing made easy

Faster EOBs through automated repricing.

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HEALTH SOLUTIONS

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Discover how Milliman helps provider organizations navigate changing reimbursement models, patient expectations, and regulatory requirements.

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INSIGHT

Related insight

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USE CASE

Medicare repricing doesn’t have to be complicated

The Medicare Reference Pricer provides the detailed methodology behind repricing each claim, making it easier to resolve disputes and avoid overpaying for services.

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We’re here to help

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