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Pricing

Updated on December 15, 2021

The SCE has as series of tools to support the pricing and calculations of the base rate for services on claims.

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These include finding the appropriate rate sheet, pricing from an authorization, integrating to NetworX Pricer ®, and the prioritization of various prices to set a “winning” price that can be applied on the claim.

CapabilityDescription
Rate sheet selection

The SCE can correctly identify the appropriate rate sheet for a contracted provider and, if necessary, split the claim when the claim dates of service span multiple rate sheets.

  • Select contracted rate sheet
  • Split claim
NetworX Pricer ®

The SCE has an out of the box integration to NetworX Pricer. The results from NetworX Pricer are applied to the claim for subsequent processing.

  • Integration
  • Apply price
Pricing

The SCE has a couple of models to support simple price identification for testing; these include non-par and par pricing. The SCE can also apply a price from an authorization.

  • Calculate price
  • Apply authorization price
Winning price

The SCE incorporates a model to identify the winning price on the claim based on a series of pricing attributes. Once the appropriate allowable is identified, the base rate for the service will be applied for use in calculations.

  • Identify winning price
  • Set allowable price
  • Set allowable base rate

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