Batch repricing

Inpatient MS-DRG claims, repriced and analysed in bulk.

Claims

Claims file

Free tier: the first 10 ready rows price per run, up to 40 priced claims a day. Every other row stays listed as not run, and you can price the next 10.
How your file is handled

Read in your browser. Only the mapped pricing fields go to the pricing engine (with diagnosis and procedure codes, when mapped, for regrouping), and each distinct hospital (CCN, NPI or name) goes once to the hospital search; paid amounts and claim IDs stay on this page. Claim rows are never saved or put in links.

An 837I of many claims becomes one row per claim. Patient names, member IDs, birth dates (kept as an age), addresses and notes are removed in this browser before the file is sent to be split, and the claim numbers go as tokens that only this page maps back.

Or paste CSV rows

Payment options

Applies to every row. Turn one off to reprice under a contract that carves it out.

Results

Sample run of 7 claims, saved from the pricing engine. Load your own file or another sample, or press Price rows to run these rows live. Load your file

Allowed by MS-DRG

Select a bar to filter the table
Download
Claims in this batch. Select a row for its detail.

Claim detail

Select a row in the table to see its inputs, the engine's result and any issues.

Reading the results

Hospital
Each row prices at the hospital its CCN, NPI or name resolved to under step 3. A CCN the search confirms needs no prompt; an NPI or name match waits for you to accept or choose it.
Allowed
The engine's expected Medicare payment for the stay at that hospital, under the options you chose. The same figure the IPPS workbench prices for one claim.
Outlier
The covered charges were high enough for a cost outlier payment, which is included in Allowed.
Paid and variance
From your file's paid column, never sent anywhere. Variance is paid minus allowed, worked out in your browser; negative means paid below expected.

Reference

Free tier

Without signing in, batch prices a set of the most common MS-DRGs at any hospital, 10 rows per run and 40 priced claims a day. Other MS-DRGs return a row error that says so.

Repricing a file of inpatient claims

Upload or paste a CSV with a DRG, a hospital (CCN, NPI or name), length of stay and covered charges per row. The page matches the columns, matches each hospital to its CCN, flags rows it cannot price, runs the valid rows and summarizes the result: total and average allowed, outliers and, when you map a paid amount, the variance against expected.

Views for outliers, errors and largest variance focus the table, and the export keeps every column with the run time and rate year.

Questions

How many rows can I price?

The free tier runs 10 rows per batch within the daily limit. Signing in or an API key raises the limit.

What columns are needed?

An MS-DRG and a hospital: its CCN, 10-digit NPI or name (city and state help a name match), or a wage index. Length of stay and covered charges make the outlier and transfer checks possible.

Is my file uploaded?

A CSV is read in your browser: only the rows sent for pricing go to the API, and each distinct hospital is looked up once to find its CCN. An 837I is de-identified in your browser first, and only that cleaned copy is sent, to be split into one row per claim; it is not stored.