Repricing represents a particular expertise of Spectrum Administrators, and we apply considerable technology and proven protocols to streamline processes, ensure accuracy, and manage varied fee schedules within critical turn-around times. Clients include Insurers, Physician Hospital Organizations, Preferred Provider Organizations.

Our high procedural and financial accuracy ratings, along with the technology of our robust claims processing applications, position Spectrum Administrators to provide a high level of efficient repricing services at reasonable cost. Types of claims repriced include:

• Automobile Claims
• Workers’ Compensation Claims
• Health Claims

Fee schedules utilized include those specific to individual plans, state-mandated fee schedules typically based on varying percentages of the Medicare fee schedule, and Medicode UCR.
TOP

Data Processing and Management

As most repricing is performed via our claims processing modules, Spectrum Administrators has the capacity to record similar information for repriced claims as for claims we would fully administrate for our full-service clients. It should be noted, however, as we are not paying claims, nor are we typically provided detailed, updated member information, (for instance, coordination of benefit information), the data available for repricing clients is fundamentally more limited than that which we keep for our fully administrated accounts. Nonetheless, reports capture information relative to the providers, nature of procedures billed and savings realized.
TOP

Quality Assurance

Quality control includes assessment of procedural, financial and coding accuracy and monitoring turn-around time. At present, Spectrum Administrators disseminates repricing worksheets electronically or via mail to more than 75 third-party administrators and insurers.

The repricing team is supported by the Spectrum Administrators information technologies department, customer service team and the production and mailroom staff. While the team members are typically dedicated to their assigned service lines, repricers are cross-trained to permit flexibility in meeting account demands.

Customer and provider calls relative to repricing are managed by the Spectrum customer service team. Our customer service department and affiliated technicians specialize in researching claim status and knowing client plans intimately, and are responsible for troubleshooting, problem-solving, and responding to caller inquiries, as well as the maintenance of provider files.
TOP