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 / claim

Matches 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
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Payment Integrity API

$2 / claim

Improved 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)
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Contracts EDI

$3 / claim or PEPM
or 30% of savings ($3 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
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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.

Yes! Our Contract & Medicare + Payment Integrity + METL service may be purchased for $2 per member per month.
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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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