Features and benefits
Prospective Payment System in Action
See how our Prospective Payment System automates the process of accurate editing, grouping and pricing across multiple care settings. This enhances auto-adjudication rates, claims pricing accuracy and provider relationships.
Establish fair and defensible reimbursement
We provide solutions for Medicare, Medicaid and TriCare that support inpatient, outpatient, physician and sub-acute claims. Frequent regulatory updates ensure accurate claims processing. We also offer consulting services to develop and manage custom pricing programs.
Components of the system include:
- A rate manager
- Supporting data files
- National Medicare Provider Rate Files (NMPRFs)
- An optimizer
How is our Prospective Payment System unique?
PPS integrates with most claims systems. It supports Windows®, mainframe, Unix®, AIX®, and Solaris™ operating systems. We simplify provider contracting and support flexible terms across all lines of business.
Prospective Payment System results
- 80% annual Medicare Advantage facility claims processed using PPS solutions
- Hundreds of flexible algorithms for commercial reimbursement
- Solutions for over 50 prospective payment systems across the U.S. for Medicare, Medicaid and TriCare