PAYER PAYMENT INTEGRITY

Payment Integrity can save the US Healthcare market as much as $ 360 Billion annually. What would catching 50% - 70% more aberrant claims mean to your bottom line?

Effective, Affordable Payment Integrity

In Context’s experience up to 50% of claims are paid inaccurately.  Results are dependent on the data science used to detect potential aberrations. This is where Context4 leapfrogs the competition.  The same data scientists that drive intelligence for our UCR and coding systems build our analytics logic.     

One customer ran post-adjudicated claims from their mainstream editing software through our Payment Integrity Platform.  We found that 70% of those claims still had aberrations.  Had they been corrected prior to payment, the customer would have avoided $ 3 Million a month in errant payments.

The Context real-time, cloud based Payment Integrity Platform provides comprehensive tools for cost containment including:

  • Pricing leveraging UCR and all 16 Medicare Prospective Payment Systems to facilitate price negotiations and RBP integrity checks
  • UCR for Medicare gap pricing
  • Advanced Medicare, Commercial and Medicaid analytics logic to assess payment compliance at a granular level
  • Fraud, waste and abuse (FWA) detection at the member and provider levels