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.
Milliman Medicare Reference Pricer features
Live medical claims pricing
Adjudicate claims quickly using Medicare fee-for-service payment methodologies.
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.
Products related to Milliman Medicare Reference Pricer
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.
GlobalRVUs
Analyze healthcare relative value units (RVUs) across all healthcare services and provider types, using any data set.