One claim. The right Medicare pricing path.
Stratica routes CMS-1500 and UB-04 claims to the applicable Medicare methodology, preserves the pricing evidence, and gives reviewers a clear path from submitted line to repriced result.
Medicare repricing from intake through audit
Built for teams that need more than a number—they need to understand and revisit the result.
Unified claim intake
Start with CMS-1500 or UB-04. Institutional bill type and claim details guide the applicable pricing lane.
Professional and institutional pricing
Price across MPFS, CLFS, DMEPOS, ASP, OPPS, IPPS, ASC, CAH, and FQHC/RHC methodologies.
Saved claim work queue
Create numbered drafts, return to claim history, edit inputs, and reprice when claim or reference data changes.
Provider and facility context
Resolve hospitals and providers by identifiers such as NPI and CCN to support the correct local pricing context.
Explainable results
Review line dispositions, pricing components, mappings, reference periods, warnings, and calculation provenance.
EDI and batching
Import 837 or structured CSV claims, apply shared repricing logic, and generate repriced exports with explanation codes.
From claim entry to defensible result
Stratica keeps the original inputs, selected Medicare path, reference context, and repriced output connected.
Enter or import the claim
Create a CMS-1500 or UB-04 draft, or bring claims in through EDI and batch workflows.
Resolve the Medicare methodology
Use claim form, bill type, provider/facility context, procedure codes, modifiers, and service dates to select the route.
Price against governed references
Apply the appropriate CMS fee schedule, prospective-payment logic, wage context, or cost-to-charge methodology.
Review, explain, and export
Inspect line and claim totals, warnings, audit context, and exports; edit and reprice when necessary.
Designed for accountable pricing operations
Authentication, tenant-aware access, role-based permissions, activity records, pricing-run history, reference health checks, and administrative audit surfaces support controlled workflows.
Ready to reprice a claim?
Sign in to Stratica or use Fileshare for established file-exchange workflows.