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?

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 Context 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.

Built under the guidance of our team of certified clinical and health benefits experts, the real-time, cloud-based Context Payment Integrity Solution delivers:

  • Visibility into suspicious billing and treatment practices at the provider level using our sophisticated rules engine and thousands of pre-built rules.
  • Actionable insight into the problems identified, with options for resolution.
  • Pre-built analytics to identify provider aberrant utilization patterns within your entire health plan.
  • Analysis across all professional and facility claims within all coverage types so no part of your health plan goes unguarded.

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