OPIS Pre-Pay/Pre-Pricing™

Core Concept: Applying edits or pricing methodologies before the claims are paid, thus eliminating recovery. SPN can take in a NDC, price the product based on that NDC and pricing methodology, and  then convert the NDC to the appropriate HCPC code.

Pre-Pay: Post-adjudicated claims that are scheduled to be paid are run through the OPIS system and validated, at which point the client is notified of any overpayment, can suspend payment on all overpaid claims and then pay the correct amounts. This service offering is attractive based on the fact that there is no associated recovery process.

Pre-Pricing: SPN can provide pre-pricing services to payer clients prior to claim adjudication. Pre-Pricing differs from Pre-Pay in that the claim is priced and subjected to various edits prior to the payer internally adjudicating the claim.