PAYER PAYMENT INTEGRITY

Payment Integrity can save the US Healthcare market as much as $ 226 Billion annually. What would reducing claims payments by 5% - 35% mean to your plan?

Immediate, Actionable and Defensible

Our Payment Integrity solution isn't a secondary product line or a check box for RFP's.  Providing analytics and detection products to enforce plan integrity is our primary business. Our cloud based platform delivers immediate insights that are actionable and defensible to produce rapid results. Stop wasteful and fraudulent claims before you pay!  Or check paid claims to recover monies paid.  

In Context’s experience up to 50% of claims are paid inaccurately. Results are dependent on the data science used to detect potential aberrations.  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.  

This is where Context leapfrogs the competition. The same data scientists that drive intelligence for our UCR and coding systems build our analytics logic. The Context4 Payment Integrity Platform provides comprehensive tools for Payment Integrity including:

  • Advanced Medicare, Commercial and Medicaid analytics logic to assess payment compliance at a granular level
  • FWA analytics and reporting at the member and provider levels
  • Pricing leveraging UCR and all 16 Medicare Prospective Payment Systems
  • UCR for Medicare gap pricing

Want to know the real state of your Payment Integrity?  Send us your post-adjudicated claims for a test run.  You will be surprised at the results.    


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