Context4 Reference-Based Pricing

Accurate data and cutting-edge cloud technology combine to create a proven and defensible Medicare reference-based pricing (RBP) solution.



Reference-Based Pricing Simplified

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Accurate, Proven, and Defensible

Health plans need reference-based pricing (RBP) that’s accurate, proven, and defensible ­– otherwise, they face pushback from providers, balance billing to members, and dissatisfaction for the employer group. But RBP calculations for reimbursement are often complex, inconsistent, and confusing.

Context4 Reference-Based Pricing makes reference-based pricing simple. We’re leading the way in the new age of healthcare pricing with our in-depth, accurate data and cutting-edge cloud technology. These ingredients combine to deliver a proven, defensible healthcare pricing solution with total Medicare gap-fill and unmatched accuracy.




Comprehensive and Adaptable

If it’s Medicare reference-based pricing (RBP) you need, Context4 Reference-Based Pricing uses the CMS Prospective Payment Systems within our real-time processing engine to calculate the pricing. For UCR RBP, we use our industry-leading UCR data. Either way, you get accurate and real-time pricing results.

Context4 Reference-Based Pricing is part of the Context4 Health Plans Suite, our modular, integrated technology platform. Implementation is effortless, and the service is secure, immediate, and reliable.

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Accurate Medicare Reference-based Pricing

The fact is that the only way to accurately calculate a Medicare reference-based price is to use the Medicare software as the method. Anything else isn’t Medicare based. That means the providers may not accept it and will balance bill your members. You don’t want to deal with that.

Why is Context4 Reference-Based Pricing accurate and completely automated when so many others are not? There are a few reasons:

  1. Context4 Reference-Based Pricing uses the actual Medicare software without any interpretation. Our pricing never deviates from Medicare.
  2. We’ve cracked the secret on the Medicare provider CCN number and how to map it to the provider NPI on the claim. This is absolutely required to accurately price to Medicare in real time.
  3. Using the provider CCN is essential in accurate Medicare pricing. Each provider may be paid differently by Medicare based on parameters specific to them. Context4 Reference-Based Pricing does it right for each provider. This is important to try to eliminate provider pushback.


The Complete RBP Solution



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All Medicare Prospective Payment Systems (PPS), fully automated

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Context’s leading UCR fee data

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The ability to have the solution return a percent of Medicare to you



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Cloud-based for easy implementation

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Updated weekly

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No data to manage or software to maintain



Contact us to learn more about what true Medicare Reference-Based Pricing can do for your organization.