One customer ran post-adjudicated claims from their mainstream editing software through the Context 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. What if this was happening to your MCO?

Independent and Affordable Program Integrity

Context supports Program Integrity through extensions to our Payment Integrity Platform.  These extensions move beyond detection of errors and Fraud, Waste, and Abuse (FWA) to allow a full lifecycle approach to compliance governance.

Our real-time, cloud based Program Integrity solutions include:

  • Medicare Prospective Payment Systems (16 PPS)
  • Advanced Medicaid, Medicare and Commercial analytics logic to assess payment compliance at a granular level
  • FWA logic and reporting at the member and provider levels
  • Case management system extensions to pass potential aberrations detected into a functional workflow system in the cloud or your SIU
  • Special investigation business partnerships to facilitate resolution of aberrations for your CMIP