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Why Medicare-based pricing, and why now. The healthcare landscape has never gone through as significant a change as it is experiencing right now. Medicare-based pricing, or a multiple of Medicare, is becoming the standard in PPO replacement, out-of-network reimbursement, and aiding in the claim negotiation process. Payers, third party administrators, self-insured employers, and others managing healthcare claims risk are looking to replace or augment their existing primary and supplemental network programs by using Medicare rates to drive increased plan savings.]