Reimbursement Manager

A contract modeling and claim repricing solution for health plans that want to assess alternative pricing options, monitor contract compliance, and evolve reimbursement strategies.

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Simplify Provider Contract Analysis


Identify savings opportunities with increased transparency. Interactive dashboards help you visualize claims costs for a more complete view of the services and providers driving price increases.


Support provider negotiations via a flexible, intuitive user interface. Provider management teams can quickly model proposed contract rates and adapt models based on provider counter-proposals.


Monitor contract and provider performance over time, helping to improve provider compliance and the accuracy of payment processing.


Expand pricing options with integrated third-party rate schedules, such as Medicare fee schedules, that increase available pricing options and improve the accuracy of payment and pricing models.


Automate pricing processes with an integration framework that streamlines the sharing of repricing terms to help reduce your administrative costs and improve pricing accuracy.


Implement innovative payment models and evaluate their performance, supporting the transition to value-based reimbursement.

Model Contract Performance and Pricing Alternatives


Rate schedule management

  • Implement sophisticated reimbursement strategies and rate differentials based upon member, product, provider, service, and client-specific attributes, with an intuitive rate schedule hierarchy.
  • Configure complex pricing logic with rate-schedule criteria that support the configuration of all reimbursement elements, including products, programs, service categories, service groups, and payment methods.
  • Access a self-service library of rate schedule pricing components, or create payment criteria using industry standard operators and critical information such as relevant claim and non-claim data and user-defined data elements and fee schedules.

Comprehensive modeling scenarios

  • Access rate schedules, product details, and historical claims to build and deploy model scenarios. Pricing calculations leverage multiple data points to provide you with visibility into all key model components.
  • Drill into relevant data points via interactive dashboards. Compare overall medical costs of rate schedules, analyze key performance indicators, and identify outliers and quality of care issues impacting medical cost.

Reimbursement lifecycle automation

  • Deploy Reimbursement Manager with Contract Manager to help you improve the accuracy of complex payment arrangements and streamline the introduction of new pricing methodologies.
  • Automatically import rate schedule variables created during modeling into Contract Manager contract templates, eliminating the delays and potential errors caused by sharing manually created rate worksheets.

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