Free first review
Send 20 claim lines. Get each one back priced, step by step.
For health plans, hospitals and physician groups. Each line comes back priced at Medicare, next to what was paid, with every difference explained and flagged, over or under. Just one claim that looks wrong? Price it here first.
- You send
- Up to 20 lines, or one rate exhibit
- Leave out
- Names, addresses, member and account IDs, claim numbers, all dates
- You get back
- A spreadsheet with each line priced and explained, plus a one-page summary
- Back in
- 5 business days after the file arrives
- Cost
- Free, one per organization. Mutual NDA on request
Pick the review that fits your desk
Health plans and TPAs
Claim pricing check
For payment integrity, claims operations and configuration teams.
Send: 20 lines your system already priced, with billed, allowed and paid, and the contract basis (percent of Medicare or your fee schedule). Test claims with no real member behind them are ideal. Medicaid lines: name the state and we'll confirm we price it before you send.
Get back: our price for each line at Medicare and, where you send it, at your contract basis; the step where your system and ours differ (wage index, outlier, transfer, multiple-procedure cut, rate year), and the bundling and unit-limit result.
Contracting, plan or provider
Rate exhibit check
For network, managed-care and reimbursement teams before a renewal.
Send: one rate exhibit or offer (percent of Medicare, case rates, stop-loss terms), the hospital it applies to, and its top DRGs with discharge counts.
Get back: what the percent actually pays on that mix, which parts of "Medicare" the definition leaves out, and the clauses that change the payment, quoted. A pricing read, not legal advice.
Providers and billing companies
Paid-claim check
For revenue integrity, patient financial services and billing teams.
Send: 20 paid Medicare Advantage or percent-of-Medicare lines from one payer, with charges, allowed and paid, and the contract basis. Billing companies: one client per free review, and only one that has agreed.
Get back: each line priced at your own Medicare factors and locality, next to what was allowed and paid, with the reason for each difference, over or under, including multiple-procedure, bilateral and assistant-at-surgery cuts.
The column template (CSV) lists every field. Rather not send anything yet? Price up to 10 claims at a time yourself on Batch repricing.
One sample line, priced two ways
| Line | Code | Original Medicare | Medicare Advantage (MA) out-of-network rule | Difference | Why they differ |
|---|---|---|---|---|---|
| 1 | MS-DRG 871 | $22,392.69 | $15,842.66 | $6,550.03 | The operating teaching add-on (IME) and the per-diem pass-through, which Original Medicare pays the hospital separately for MA enrollees, so the MA rule leaves them out. Expected under the MA out-of-network rule, not a pricing error. |
The steps behind the $22,392.69
| Step | Input | Amount |
|---|---|---|
| Operating DRG payment | weight 1.9320, wage index 0.9909 | $13,155.69 |
| Teaching add-on (IME) | hospital's teaching factor | $1,740.13 |
| Capital | hospital's capital factors | $1,156.00 |
| Uncompensated care | per-claim amount | $1,375.95 |
| Pass-through | $801.65 a day × 6 covered days | $4,809.90 |
| Value-based purchasing | factor 1.012283 | $161.59 |
| Readmissions reduction | factor 0.9995 | −$6.58 |
| Outlier and transfer | not reached; full DRG | $0.00 |
| Total | rounded steps shown sum to $22,392.68 | $22,392.69 |
Read from either side. A plan that paid this out-of-network stay at $22,392.69 would see $6,550.03 flagged as paid above the MA rule; a hospital paid $15,842.66 by an MA plan would see nothing flagged.
Why trust the numbers
The test set is inpatient. A professional line shows the RVUs, the locality adjustment, the conversion factor and any multiple-procedure, bilateral or assistant cut as separate steps. PayerParity is a small, early-stage company; the free review is how you check us.
How it works
- Ask. Fill in the short form below. Don't put claim data in it.
- Send. We email you how to send the file, by encrypted email. Lay it out like the template. We take three reviews a week; if we're full, you get a start date before you send anything.
- Review. Back within 5 business days of the file arriving: a spreadsheet and a one-page summary.
- Decide. If it holds up, the paid step is a full-file audit: the same spreadsheet for every line in the file, with totals by reason. From $2,500, tiered by line count, quoted in writing first. A check after each rate release is $1,500. No obligation.
Request a free review
One minute. Fields marked * are required. We reply by email.
Questions
What exactly should the lines contain?
The codes (MS-DRG, CPT/HCPCS, revenue code, modifiers), units or length of stay, discharge status or place of service, the hospital's provider number or the ZIP of the place the service was performed (not the patient's ZIP), the rate year, billed charges, the amounts allowed and paid, and the contract basis. Number the lines 1 to 20. A line is one inpatient stay, or one service line on a professional or outpatient claim. Rate year means the federal fiscal year for inpatient, skilled nursing and other post-acute stays, and the calendar year for professional, outpatient, home health and dialysis lines.
What should I leave out?
Patient names and addresses, member IDs, patient account and record numbers, claim numbers, and every date (birth, admission, discharge, service). Keep the notes column free of patient details. A rate year and length of stay are enough to price an inpatient stay; a rate year is enough for most professional and outpatient lines. If a line depends on the quarter (a drug, a mid-year code, an outlier stay), flag it in the notes column and we'll price it for each quarter of that year. Test claims with no real member behind them can keep their dates; copies of production claims can't.
Do you sign an NDA?
Yes, on request: a mutual NDA, ours or yours, signed before you send anything. Many contracts keep rate exhibits confidential, so check that yours allows sharing with an adviser under NDA.
Why is it free, and what comes after?
Because 20 lines, or one exhibit, you already know the answer to is the fastest way to judge whether the method holds up. If it does, a full-file audit, a check after each rate release, or API access is quoted in writing as a fixed scope before it starts.
Who does the review?
PayerParity, an independent pricing company in Sugar Land, Texas, which runs this site.