About Milliman Medicare Reference Pricer
Milliman Medicare Reference Pricer is a cloud-based healthcare software solution designed for real-time Medicare claims payment and auditing. It enables healthcare organizations to adjudicate medical claims using Medicare fee-for-service methodologies, apply customizable fee schedules, and benchmark reimbursement rates.
Milliman Medicare Reference Pricer is a specialized healthcare software platform designed to help payers, providers, and third-party administrators navigate the complexities of Medicare reimbursement. By providing real-time adjudication and auditing capabilities, the tool allows organizations to standardize their payment processes and reduce administrative inefficiencies. Its core strength lies in its flexibility; users can customize fee schedules, apply alternative payment weights, and extend Medicare-based pricing to commercial or individual claims. The platform is cloud-native and designed for integration via web services or batch processing, making it a versatile choice for enterprise environments. While it is a powerful tool for financial planning and payment integrity, it is best suited for organizations that require deep actuarial-backed precision in their claims processing and contract benchmarking.
Pros & Cons
- Provides real-time adjudication using current Medicare fee-for-service methodologies.
- Offers high flexibility to customize fee schedules and payment components.
- Automates updates from CMS to ensure compliance with the latest rates.
- Supports seamless integration with existing claims systems via web services or batch processing.
- Enables standardized benchmarking for commercial and Medicare Advantage contract negotiations.
- Requires specialized knowledge of Medicare payment rules to configure effectively.
- Pricing is not publicly disclosed and typically requires a custom quote or demo.
- High dependency on Milliman's proprietary data and update cycles for system accuracy.
Features
Key features
Processes medical claims quickly using Medicare fee-for-service payment methodologies.
Allows users to select alternative payment weights, enable extended fee schedules, and set outlier pricing methodologies.
Additional features
Includes MS-DRG and APC groupers for accurate and efficient classification of medical services.
Provides audit trails and historical pricing data for validation and reconciliation.
Generates detailed output and reporting workbooks to support financial analysis and contract performance monitoring.
Includes built-in code editing to ensure claims meet Medicare policy requirements.
Offers configurable methodologies for handling outlier claims.
Supports specific payment weights for maternity and newborn care scenarios.
Enables comparison of reimbursement rates against market benchmarks or cost-based models.
Pricing
Countries & Languages
Interface languages
Billing currencies
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About Milliman Medicare Reference Pricer
Milliman Medicare Reference Pricer is a cloud-based healthcare software solution designed for real-time Medicare claims payment and auditing. It enables healthcare organizations to adjudicate medical claims using Medicare fee-for-service methodologies, apply customizable fee schedules, and benchmark reimbursement rates.
Milliman Medicare Reference Pricer Details
Milliman Medicare Reference Pricer's In-App Market Place
Does Milliman Medicare Reference Pricer have an in-app market place?
Yes
How many Mini-Apps in the marketplace?
0
Mini Apps
Pricing Options
Accepted Payment Currencies
USD ($), EUR (€), GBP (£), AUD ($), CAD ($), JPY (¥), CNY (¥), INR (₹), BRL (R$), MXN ($), RUB (₽), KRW (₩), TRY (₺), ZAR (R), IDR (Rp), HUF (Ft), PLN (zł), SEK (kr), DKK (kr), NOK (kr), SGD ($), THB (฿), MYR (RM), VND (₫), PHP (₱), CHF (CHF), CLP ($)
Pros & Cons
- Provides real-time adjudication using current Medicare fee-for-service methodologies.
- Offers high flexibility to customize fee schedules and payment components.
- Automates updates from CMS to ensure compliance with the latest rates.
- Supports seamless integration with existing claims systems via web services or batch processing.
- Enables standardized benchmarking for commercial and Medicare Advantage contract negotiations.
- Requires specialized knowledge of Medicare payment rules to configure effectively.
- Pricing is not publicly disclosed and typically requires a custom quote or demo.
- High dependency on Milliman's proprietary data and update cycles for system accuracy.
Milliman Medicare Reference Pricer's Support Options
Contact
+1 (206) 203-2465Community Forums
https://community.milliman.com/Milliman Medicare Reference Pricer's Alternatives
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