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Virtual Benefits Administrator and Context4 Healthcare, Inc. announce real-time Medicare pricing automation

  • by John Danza
  • Oct 4, 2017, 10:00 AM

Virtual Benefits Administrator and Context4 Healthcare, Inc. are pleased to announce the release of real-time Medicare and UCR pricing.  This latest addition expands VBA’s process automation in Real-Time Claims Payment (RTCP).  

Available to VBA subscribers today, this solution provides real-time Medicare Prospective Payment System (PPS) pricing during claims processing.  Direct PPS pricing ensures compliance with the Centers for Medicare and Medicaid Services (CMS).  It eliminates complexity and the need to utilize less accurate substitutes like RBRVS.  

The real-time Medicare pricing feature eliminates wasteful, manual processes that drive cost and human error.  Automated NPI to CCN reconciliation significantly simplifies institutional pricing.  Built in PPS intelligence automatically chooses which of the 17 PPS best fits each and every line in a claim without human intervention.  

The Medicare solution also integrates Context4 Healthcare’s industry-leading Usual, Customary & Reasonable (UCR) fee data.  This ensures VBA customers have Medicare gap fill pricing for the approximately 800 procedures not priced by CMS.  The inclusion of real-time Medicare pricing extends value beyond Context’s advanced editing and FWA detection.  The VBA / Context solution is one-of-a-kind in the health payer industry.  

Mark Earles, CEO at Context4 Healthcare, stated: “VBA is known for innovation in employee benefit administration.  Medicare pricing is complex and time consuming.  Context is proud to be a part of this advancement in automation and payer value.”  

Tom Witter, President of Virtual Benefits Administrator, stated: “VBA is deeply committed to process automation that drives ROI.  Real-time Medicare pricing expands our relationship beyond advanced claims editing with Context.  It illustrates our agility in integrating best of breed features to maximize value for our customers.”  


About VBAHeadquartered in Germantown, WI, VBA has over 20 years of experience in software development for health benefits administration.  Our mission of providing Flexibility, Functionality, and Technology for our clients’ business solutions ensures they will optimize their daily business processes and deliver the highest level of customer satisfaction.


About Context4 Healthcare, IncHeadquartered in Naperville, IL, Context4 Healthcare has nearly 30 years of experience in healthcare software and data product development.  Context is a leading provider of cloud based healthcare compliance and payment integrity solutions.  These solutions serve hundreds of payer and provider clients, positively impacting millions of lives globally.

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