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.
FEATURES
Easy to use Web Portal based management interface
Auto-repricing
Out-of-network pricing
Special routing for special re-pricing needs
Flexible rule-based extensible repricing engine
Fully integrated into the ClaimsBridge Web Portal