2025 NHCAA Members
Payment Integrity to Empower Your Organization
Controlling the Risk of Fraud, Waste, and Abuse
The strength of your health plan’s service to your members relies on your focus in determining accurate plan liability. Payment Integrity is essential for making sure that a health claim is paid per contract terms and without waste, abusive practices or fraudulent intent.
This isn’t just calculating the claim correctly. It’s about making sure that the claim accurately represents the services rendered. Detecting aberrant patterns in healthcare claims is key to defending against the threat of fraud, waste, and abuse, which siphons hundreds of billions of dollars each year from the healthcare system.
Analysis that Empowers Your Organization
Context4 Medical and Dental Payment Integrity combines a deep library of pre-built rules with an array of pre-built analytics and user-driven data extracts. All of this helps you to identify potential FWA situations affecting your dental plan today, and analyze the data needed to investigate those cases.
You’ll be made aware of potentially fraudulent claims before you pay, increasing the efficiency of your operations and lowering costs. Rapid isolation of FWA is not just important for your bottom line, but for the health and welfare of plan members.
Reference-Based Pricing, Simplified
Putting Healthcare in Context
The healthcare industry is full of challenges, from complex regulations to skyrocketing costs. But protecting the integrity of your health plan and determining accurate pricing should be simple. Too many healthcare software solutions create more problems than they solve, with convoluted installation, confusing interfaces, and poor integration – burdening healthcare companies with high costs and lost efficiency. But here at Context 4 Healthcare, we’ve built the next generation of healthcare compliance and cost control solutions.
The Complete Pricing & Integrity Solution
The Context4 Health Plans Suite is a modular solution built on a single integrated technology platform. With over 30 years in the industry and a team of the best software developers and healthcare experts, we’ve created a cloud-based software solution that is flexible, secure, and easy to implement. Payers can choose to utilize Payment Integrity and Reference-based Pricing together for their plans, or separate them out when the needs of the plan require it. It’s all done through a single interface. Using the Context4 Health Plans Suite lets your plans operate under an umbrella of complete compliance.
Your Trusted Source for Healthcare Data
The Healthcare Data Challenge
In today’s complex healthcare environment, having access to accurate and up-to-date data is crucial to success. Building and maintaining this knowledge base is difficult, time-consuming and costly. Compliance starts with timely, accurate, and relevant healthcare data. In order to drive value and support compliance in your organization, you need data from a source you can trust.
Building a Data Partnership
When it comes to healthcare data, we hold ourselves to a higher standard of accuracy so that your organization can maintain a clear view of the challenges and opportunities ahead. We make it easy to access and maintain a holistic master data set, providing the latest coding, fee, and regulatory data to help you maximize productivity and compliance.
Our 100+ data products integrate seamlessly with your existing IT platforms, and we can create custom data products to meet your needs. You’ll also benefit from our renowned client support and decades of experience, with professional guidance on coding, rules usage and compliance. This is why we have been the leading choice for over 1,000 payers, providers, and software developers for more than 30 years.
CPT copyright 2024 American Medical Association. All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
