Claim Repricing and Payment Integrity
Contract and Medicare Claim repricing with payment integrity built in.
We make it as easy as 1, 2, 3!
Medicare API
$1 / claimMatches CMS rules
- Accurate Medicare repricing
- Diagnosis Related Group (DRG) grouper
- Price with claim DRG or grouped
- API access only
- Results in milliseconds
- Programmer-friendly client libraries
Payment Integrity API
$2 / claimImproved cost savings
- Everything in Medicare API
- Price twice to find lowest price
- Lowest DRG price (claim or grouped)
- Claim edit failure details & overrides
- Commercial code crosswalks
- Synthetic non-Medicare rates
- National Correct Coding Institute checks
- Medicare Unlikely Event checks (soon)
Contracts EDI
$3 PEPM or$2 PMPM or
$3 / claim or
10% of savings ($4 cap)
Complete repricing flexibility
- Everything in Payment Integrity API
- METL Repricing Basic plan
- Flexible contract pricing
- EDI support
- Fewest claim errors
- Most claims returned same day
- Daily claims aging report
- Manual pricing UI
- Pricing accuracy support
Frequently Asked Questions
Common questions about our repricing services
We’ve had customers start using our API services in production in just a couple of days. EDI integration can be done in as little as a week. Our goal is to move as quickly as you can.
If you’ve got a written quote from a vendor for lower than our published prices, reach out. We’ll meet or beat any equivalent service quotes.
It stands for Per Employee Per Month.
It stands for Per Member Per Month.
Looking for even more?
We act as the backend for several amazing service providers that offer complete plan solutions including balance bill and access issue support, provider contracting, cash pre-pay, nationwide provider networks, and much more. Let us know what you're looking for and we'll help you find a great service provider for your needs.
Likewise, if you are an innovator looking to build a new healthcare solution to lower costs and improve care in this country, reach out. We'd love to help!
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