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Explaining Health Insurance Claims Repricing

Health insurance claims repricing is one of the best ways to alleviate the burden when a patient needs to rely on their health insurance. With private insurance companies still more prevalent than public coverage, at a rate of 67.3% using private coverage, claims repricing is a major part of the healthcare industry.

It works between a third party administrator healthcare service and the healthcare provider. This means that the biller (healthcare provider) will send the third party administrator (insurance company) the billed charges for the patient’s medical bills. At this point, the claim is adjudicated. Essentially, this means that they settle the bill. In the process, various terms on the bill are repriced. There’s a lot that can be changed in this process of health insurance claims repricing, including case rates, per diems, and percentage of discounts. Once repricing has concluded, you have the final price. This is the amount that is split between a health claims administrator and the patient. How it is split is dependent on the agreement between these two.

This can be a long and trying process for the health insurance provider, but the benefit that customers get out of the process is worth it. Health insurance claims repricing prevents errors in billing, which can come from a mistake in the system being used to generate a bill. Unfortunately, mistakes in billing aren’t uncommon, as the amount of work that goes into billing for a hospital can be overwhelming, but that’s why the repricing process is important. It also stops patients from being overcharged by their healthcare provider. While not common, fraudulent charges do occur, but this process is designed to catch those failures.

On a broader scale, this process helps the insurance companies by providing them greater detail about charges and cost in the healthcare industry. This allows them to better reconstruct and construct claims. It also gives them a chance to rebuild future claims more effectively, because they know what to look for going forward.

Repricing is more than important; it is vital to healthcare. Health insurance claims repricing helps keep medical bills manageable for patients, who are often vulnerable at these times. After all, people rarely have to rely on health insurance when they don’t have a medical issue. This lets the patient focus on getting healthy and taking medical advice, rather than focusing on their healthcare service and what health claims administrators are doing.