Ashland, Oregon – March 4, 2014 – Context4 Healthcare, Inc., a leading provider of software solutions for challenges related to detection of fraud, waste, and abuse in the healthcare industry, and PLEXIS Healthcare Systems, a leading provider of enterprise-class, state-of-the-art healthcare benefits administration software, today announced a partnership that will enable PLEXIS’ clients using the Quantum Choice healthcare benefit management technology to easily implement the Context FirstPass claims editing solution in order to streamline their adjudication process while increasing claims auto-adjudication rates.
The integration of Context’s FirstPass real-time claim editing solution with the PLEXIS Quantum Choice software provides customers with the seamless use of Next Generation technology from two leaders in their fields. During the adjudication process, FirstPass utilizes real time editing, firing rules containing millions of code combinations to identify professional and facility claims that are non-compliant, inaccurate, or require investigation for fraud, waste, or abuse (FWA) before they are paid and populate downstream applications. The pre-payment detection of potential FWA situations is key to effective management of the health plan’s costs and provides a clear alternative to the traditional FWA “pay and chase” administration model. With the FirstPass integration, PLEXIS’ Quantum Choice customers will be able to take immediate action upon claim issues found by FirstPass, making corrections that increase payment accuracy.
“PLEXIS reviewed the capabilities of many claim editing solutions on the market today when determining which one would make the most sense to meet our clients’ and target markets’ particular needs. To start, the product/service had to be able to work effectively in real time as an extension of Quantum Choice’s auto-adjudication process; as well, the chosen vendor had to have flexible pricing offerings for our diverse client base. We found the FirstPass solution from Context to be the one that provided the most value for our particular needs, and given that PLEXIS had an existing relationship with Context (for use of its UCR data for pricing claims), it made sense to expand that relationship with FirstPass”, said Sean Garrett, COO of PLEXIS. Mark Earles, President and CEO of Context notes, “We’re excited to be working with an advanced technology partner such as PLEXIS. Introducing FirstPass into Quantum Choice for real-time editing will allow our mutual customers to realize immediate savings through increased claims payment accuracy and advanced fraud, waste, and abuse detection, all the while reducing overall administrative cost.”
About Context4 Healthcare, Inc.
Headquartered in Naperville, IL, Context4 Healthcare develops software and data solutions to solve complex medical claim coding, editing, and fraud related abuses. For over 20 years, Context’s software and data solutions have enabled healthcare organizations to reduce claim errors, denials, and claim-handling costs. Context’s customers include insurance carriers, third party administrators, managed care organizations, hospitals, and physician practices. Learn more at http://www.context4healthcare.com/. For additional information please contact David Terry at 630-321-2976 or firstname.lastname@example.org
About PLEXIS Healthcare Systems
PLEXIS Healthcare Systems is a leading payer solution and claims processing technology company based in Ashland, OR. Founded in 1996, PLEXIS software and services now process millions of claims transactions daily for healthcare payer organizations throughout the United States and internationally. PLEXIS’ family of core software products includes Plexis LCS for small and medium size third party administrators, self-funded groups and self-governed tribes; PLEXIS Claims Manager for mid- size domestic and international healthcare organizations; and MITA 3.0-aligned PLEXIS Quantum Choice, for government healthcare organizations and health and dental plans. PLEXIS’ solutions enable government healthcare organizations, health plans, TPAs, and provider groups to reduce costs, automate claims processing and payment routines, enhance customer satisfaction, and help expand market share. For more information, please call toll free (877) 475-3947 or visit www.plexisweb.com.