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Pricing

Suggest edit Updated on August 31, 2021

The SCE has as series of tools to support the pricing and calculations of the base rate for services on claims.

These include finding the appropriate rate sheet, pricing from an authorization, integrating to NetworX Pricer ®, and the prioritization of various prices to set a “winning” price that can be applied on the claim.

CapabilityDescription
Rate sheet selection

The SCE can correctly identify the appropriate rate sheet for a contracted provider and, if necessary, split the claim when the claim dates of service span multiple rate sheets.

  • Select contracted rate sheet
  • Split claim
NetworX Pricer ®

The SCE has an out of the box integration to NetworX Pricer. The results from NetworX Pricer are applied to the claim for subsequent processing.

  • Integration
  • Apply price
Pricing

The SCE has a couple of models to support simple price identification for testing; these include non-par and par pricing. The SCE can also apply a price from an authorization.

  • Calculate price
  • Apply authorization price
Winning price

The SCE incorporates a model to identify the winning price on the claim based on a series of pricing attributes. Once the appropriate allowable is identified, the base rate for the service will be applied for use in calculations.

  • Identify winning price
  • Set allowable price
  • Set allowable base rate
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