Batch claim repricing and analytics: inpatient MS-DRG claims

Independent pricing tool. Not affiliated with, endorsed by, or operated by CMS or any government agency. Estimates are not a claims determination.

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. Get an API key for 200 rows per call.

Read in your browser. Only the mapped pricing fields go to the pricing engine; paid amounts and claim IDs stay on this page. Nothing is saved or put in links.

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 press Price to run these rows live.

Allowed by MS-DRG

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

Detail

Claim detail

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

Free tier

Without an API key, 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.

Get an API key for every MS-DRG and 200 rows per call

Reading the results

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.

Repricing a file of inpatient claims

Upload or paste a CSV with a DRG, hospital CCN, length of stay and covered charges per row. The page matches the columns, 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. An API key raises the limit.

What columns are needed?

DRG and CCN at minimum; length of stay and covered charges make the outlier and transfer checks possible.

Is my file uploaded?

Only the rows sent for pricing go to the API. The file is read in your browser.