Payor Solutions

FirstPass^™ is software tool that applies billing guidelines to medical claims. By applying these guidelines to claims prior to entering an adjudication system, errors may be spotted or eliminated before they are populated in downstream applications.

The FirstPass^™ claims software tool allows health plans and payor organizations to check for all key clinical editing functions. These edits range from basic checks for accuracy of codes, appropriate use of modifiers, and validation of patient gender and age, to complex relationships such as instances of code fragmentation, utilization violations, mutually exclusive services, diagnosis/procedure relationships, and more.

Context⁴Healthcare UCR offerings allow insurance companies, employer groups, and other healthcare organizations to have direct access to the physician fee schedule information that is necessary to operate in today’s diverse and widespread healthcare environment. The Context UCR databases were developed over several years by a team of fee experts and mathematicians. As a result, users can now acquire cost-effective physician fee management solutions that are exceptionally credible and defensible. UCR fee schedule databases are constructed using over one billion new charge points which are added annually.