Reference Based Pricing

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AMPS Reference Based Pricing encompasses three components to ensure claims are priced Fair For All. The  pricing  process begins  with  an audit  of claims using AMPS industry-leading Medical Bill Review program under the direction of AMPS board-certified Physicians. AMPS next determines the “best price” for each claim using multiple methodologies and AMPS 15 years of claims history. Finally, AMPS balances Plan Savings and Member experience by determining the “best time” to negotiate with Providers.

The Dynamic Approach

AMPS utilizes historical data, reference-based benchmarks, direct contracts, fair market value and fee-for-service pricing to calculate the “best” price for each claim. AMPS Intelligent Pricing engine can be configured to dynamically take into account Member satisfaction metrics and Plan goals to better balance Plan savings and Member experience.

Before a claim is priced, AMPS Physician Panel reviews each line of the itemized bill for billing accuracy. This ensures claim payment is made for services actually rendered and clinically relevant.

AMPS Physician Panel is equipped with machine-learning software and 15 years of historical data to identify and remove duplicate charges, non-rendered services, data entry errors, unbundling, inaccurate time charges, adverse clinical occurrences and hoteling days.

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