Repricing

A critical step in claim adjudication, repricing can be complex and time consuming.

Auto-Repricing

ClaimsBridge^® can automate much of the repricing process using business rules and pricing structures applicable to each ClaimsBridge client.

Repricing Rules

Repricing rules can be as complex as needed, based on one or more of the following:

• CPT/HCPCS

• Revenue codes

• DRG codes

• Primary diagnosis codes (case rates)

• Anesthesia

• Fixed dollar amount or percent of charges

• Reprice claim segments with different schedules

• Calculation rules hierarchy

Wrap Networks

Claims which cannot be priced by the primary network can be automatically diverted to wrap networks for processing before they are returned.