Analysis 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.
Proactive Detection Analytics
Context4 Medical Payment Integrity, part of the Context4 Health Plans Suite, 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 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.
The Power of Payment Integrity
Gain visibility into suspicious billing and treatment practices at the provider level using our sophisticated rules engine and thousands of pre-built rules.
Receive actionable insight into the problems identified with options for resolution.
Use our pre-built analytics to identify provider aberrant utilization patterns within your entire health plan.
Use our user-driven data extracts to prepare information needed for case investigations.
Analyze across all professional and facility claims within all coverage types, so no part of your health plan goes unguarded.
Without prompt and efficient detection, your plan could be prey to today’s most adaptive and insidious FWA themes. 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.