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. The software includes service-line level detailed claim adjudication outputs and a suite of reporting workbooks to assist with validation and reconciliation. The Medicare Repricer includes inpatient, outpatient, Ambulatory Surgical Center (ASC), and professional claims repricing capabilities, and replicates the Medicare claim adjudication logic including diagnosis-related group (DRG) and ambulatory payment classification (APC) grouping.

Uses of Medicare Repricer

The Milliman Medicare Repricer software has a wide variety of applications, including:

• Reference price: Percentage of Medicare comparisons provide easy to understand price relationships.
• Standardized fee schedules: Calculating providers’ current percentages of Medicare makes it easy to switch to Medicare-based fee schedules.
• Capitation fee-for-service equivalents: By repricing data to Medicare-allowed amounts, payers and providers can better understand the value of the services delivered under a capitation contract.
• Payment integrity: Independently repricing claims experience to Medicare-allowed amounts enables plans to check actual payment amounts and adjudication results.

Milliman - Medicare Repricer supports the following fee schedules:

• IPPS
• OPPS/ASC
• Professional
• Home Health
• LTCH
• IP Rehab
• IP Psych
• SNF
• Dialysis
• Critical Access Hospitals
• Average Sales Price (ASP) Drug Fee Schedule
• Ambulance
• Clinical Lab
• Parenteral and Enteral (PEN)
• Durable Medical Equipment & Prosthetics (DME-POS)
• Anesthesia
• Ambulatory Surgery Center (ASC)

Learn more

If you’d like to use this product, contact us to learn more about Milliman’s Medicare Repricer. You can also download this brochure.