MLR Maximizer

By partnering with MLR Tribal Solutions, your PRC eligible claims will be repriced using state of the art repricing processes using real time Medicare fee schedules. In contrast, the PC Pricer is actually just an “estimator”. It does not provide actual Medicare allowable rates. Don’t take our word for this, see for yourself on the CMS website…

Click here “CMS PC Pricer Page” 

This discrepancy between using an estimator (PC Pricer) and our processes should yield an additional 10-20% in savings!


There are many reasons why a certain amount of savings is being left on the table. Some of these include:

  • The PC Pricer from CMS is actually an “estimator”
  • Out dated PC Pricers & APC Manuals are used
  • Wrong PC Pricers are used
  • Wrong facility Medicare ID #’s are used
  • Misunderstanding of MLR program regulations
  • Inexperience of staff in pricing Medicare claims
  • Staff turnover
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