AMPS utilizes Reference Based Pricing with three components to ensure claims are priced fairly for all parties involved: Healthcare Providers, Health Plans, and Members. We call this Fair For All pricing. The process begins with an audit of claims by AMPS board-certified Physicians. Next, AMPS determines the “best price” for each claim using multiple reference points including AMPS 15 years of claims history. Finally, AMPS balances Plan Savings and Member experience by determining the “best time” to negotiate with Providers.
A Dynamic Approach
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 utilizes machine-learning software to identify and remove: duplicate charges, non-rendered services, data entry errors, unbundling, inaccurate time charges, adverse clinical occurrences and hoteling days. This ensures Plans and Members are only paying for the services and care they received.
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 dynamically to match the unique goals of each Plan.