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Price claims accurately.

Using the Prospective Payment System (PPS) framework, we manage even the most complex pricing solutions.

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Features and benefits

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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.

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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:

  • Groupers
  • Pricers
  • Mappers
  • Editors
  • A rate manager
  • Supporting data files
  • National Medicare Provider Rate Files (NMPRFs)
  • An optimizer
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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.

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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
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Add Prospective Payment System to your payment integrity portfolio today.

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