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Health Insurance Claim Repricing

Claim Repricing is the Application of the Contract Terms Between the Healthcare Provider (Hospital, Doctor, etc.) and the Insurance Network to the BILLED CHARGES. Billed Charges Are Submitted on a Claim by the Healthcare Provider to the Insurance Carrier. First that Claim is Adjudicated. Then the Claim is 'Repriced' per the Contract Terms. Example of Those Contract Discount Terms Include 1) Case Rates, 2) Percent of Charge Discounts, 3) Per Diems, 4) Carve Outs and More. The Final 'Price' After 'Repricing' is the Allowed Amount. The Allowed Amount is the TRUE COST OF HEALTHCARE. The Allowed Amount is then Split Between Patient Responsibility and What the Plan Needs to Pay. Sources: Claims Adjudication Video:    • Health Insurance Claims Adjudication   Hospital - Insurance Contract Negotiation Video:    • Insurance-Hospital Price Negotiations   AHealthcareZ is 200+ Healthcare Finance Educational Videos. 💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthca... AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health. 90,000+ Views Per Month Across All Platforms. Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter. #HealthcareCosts #HealthcareIndustry #ClaimsRepricing