Verify a price
One DRG price beside the CMS Web Pricer, component by component. The 5,000-claim study runs the same check at scale.
Claim
The claim to compare
The same claim goes to our engine and to the CMS Web Pricer. The admit date is optional: it only works out the covered days.
Ours vs the CMS Web Pricer
Reconciliation, component by component
Matched inputs
Reading the result
Comparison basis
Medicare Advantage, out of network, is what the CMS Web Pricer calls an HMO paid claim; the flag covers every MA plan, HMO or PPO. It is the Original Medicare amount less what Medicare pays the hospital directly: the operating IME and the GME, organ and stem-cell share of the per-diem pass-through. Capital IME, DSH and uncompensated care stay in. This check asks the CMS Web Pricer for both prices, with HMO paid claim off and on. An in-network MA claim pays the plan's contract rate instead.
If the two differ
About this check
This is an independent tool. It prices the claim through our engine and sends the same claim to the CMS Web Pricer at webpricer.cms.gov, then lines the two up. cmswebpricer.com is not affiliated with, endorsed by, or operated by CMS.
A difference of $1.00 or less counts as a match (rounding order). Over $1.00 but within 0.5% is marked close, not a match. Anything larger is shown with its dollar and percent difference.