Billed charge vs. contracted rate
A provider's billed charge is typically a standard, published rate that isn't specific to any one payer. The contracted rate is what a specific purchaser has actually agreed to pay, based on their direct contract with that provider. Repricing is the step that converts one into the other for a given claim.
Where it fits in the claims lifecycle
A claim is submitted by the provider, typically through their existing clearinghouse. It's then repriced against the applicable contract terms before final adjudication and payment. On OpenNetworks, this repricing step happens automatically as part of claim processing, using the rate and terms already agreed between purchaser and provider.
Manual vs. automated repricing
Manual repricing means a person (or a legacy rules engine) applies contract terms to each claim by hand or via static lookup tables, which is slow and prone to inconsistency, especially as contract terms get more specific. Automated repricing applies the same logic instantly and consistently to every claim, and can be independently validated against the purchaser's own data.
Why accuracy matters here
A repricing error doesn't just cost money in one direction — it can either overpay a provider relative to what was agreed, or underpay them relative to a contract they're relying on. Getting repricing right, consistently, is part of what makes a direct-contract relationship durable over time.