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Repricing Technology

RepriceNow (Internet Repricing)
In-network and out-of-network medical bills can be repriced on the Internet using any computer, anywhere, with any Internet access. It's FAST and EASY!

CAI has a four-tiered approach to achieving the greatest savings possible:

  1. If CAI is providing Primary PPO management services for your company and the claim is in-network, RepriceNow immediately reprices the claim*.
  2. If the claim is out-of-area for a traveling employee or covered dependent, and you are accessing our Travel Network, you can receive immediate in-network savings through RepriceNow.
  3. If the claim is out-of-network, RepriceNow enables you to reprice the claim through a Wrap PPO or Supplemental PPO, and provides immediate results.
  4. If a claim cannot be repriced through a PPO, you can submit the claim through RepriceNow for negotiations, regardless of the claim amount.

* Clean claims repriced through a PPO loaded in our system are returned within seconds of submitting the claim. Complicated claims or claims meeting our QA requirements may require one additional business day for repricing. Negotiated claims are returned within the time frame specified by you at implementation.

Electronic Data Interchange (EDI)
For companies with a high volume of claims to be repriced, CAI can connect with a client electronically to quickly and efficiently transport claims for repricing and back for automated adjudication. To support your move to EDI, CAI:

  • Maintains a team dedicated to EDI implementation and support efforts
  • Supports multiple formats, including proprietary formats and industry standard ANSI X12
  • Facilitates multiple data security and data transmission capabilities, including encryption, Secure FTP, and VPN
  • Integrated with a growing list of the major claim adjudication systems
If you are not currently capable of EDI, CAI can provide format specifications and assistance with data retrieval design to move you to EDI capability with minimal resource commitments. An EDI connection with CAI is typically accomplished in a matter of weeks. One of the great benefits to electronically connecting with CAI is that through this single connection you also gain access to additional PPO repricers enhancing efficiencies and reducing administrative costs.

RESULT: A Streamlined technology solution that fits your needs today AND tomorrow.
 
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