Skip to main content
CLAIM PRICING

Milliman Medicare Reference Pricer

Medicare pricing on demand

Milliman Medicare Reference Pricer banner
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

Reduce costs

Realize the results of your pricing strategy by freeing yourself from legacy contract structures and systems.

Standardize payment using Medicare

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

Ensure Pricing Accuracy

Medicare payment rules are complex and change over time. Frequently, adjustments must be applied to the fee schedule rates published by CMS for accurate pricing. The Medicare Reference Pricer is updated automatically and applies appropriate fee schedules and adjustments based on the claim service date.

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.

Download the studyNavigation Arrow
FEATURES

Milliman Medicare Reference Pricer features

Live medical claims pricing

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

Download sample outputDownload

Flexible integration

Use Medicare Reference Pricer as a stand-alone pricing module, or seamlessly integrate it with your current claim system.

Customizable data

Select alternative payment weights for maternity and newborns, enable extended fee schedules for non-Medicare covered services, choose the 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 data

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

Milliman support

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

Webinars

abstract pattern

Checking in on the Medicare Reference Pricer

Whether you already license our product or simply want to learn more, our Milliman experts discuss a range of key updates to the Milliman Medicare Reference Pricer.

Watch the webinarNavigation Arrow
A doctor with a patient

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.

Watch the webinarNavigation Arrow
A data chart

Proxy Pricing and Medicare Pricing Gaps

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

Watch the webinarNavigation Arrow
employees collaborating

Evaluating Network Performance: Discounts, Price Transparency, Percent of Medicare, & Risk Adjusted PMPM

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.

Learn moreNavigation Arrow
SERVICES

Services related to Milliman Medicare Reference Pricer

PRODUCTS

Products related to Milliman Medicare Reference Pricer

Claims data analytics
Claims data analytics

Medicare Repricer

Milliman’s Medicare Repricer software assigns Medicare-allowable fees to administrative claims data, allowing payers and providers to surface those fees in their enterprise data warehouse.

Learn moreNavigation Arrow
Healthcare cost modeling
Healthcare cost modeling

GlobalRVUs

Analyze healthcare relative value units (RVUs) across all healthcare services and provider types, using any data set.

Learn moreNavigation Arrow

We’re here to help

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