Context4 Healthcare provides automated solutions addressing the challenges payers face today. 

The Context4 Reference-based Pricing (C4RBP) Solution is our in-depth, accurate claim repricing cloud-based solution. Combining 100% accurate Medicare pricing using the full CMS Prospective Payment Systems (PPS) software with Context’s industry-proven Usual, Customary, and Reasonable (UCR) fee schedules, the C4RBP solution provides proven, defensible healthcare pricing with unmatched accuracy.

Our Context4 Payment Integrity (C4PI) Solution provides online, real-time fraud, waste, and abuse (FWA) software contains millions of editing combinations addressing thousands of potential fraud, waste and abuse situations, inaccurate billing practices, regulatory requirements, and other billing errors. Delivered in a software-as-a-service model, Context 4 Payment Integrity is available for both Medical and Dental lines of business.

Context4 Healthcare also produces a proprietary usual, customary and reasonable (UCR) fee schedule by analyzing billions of claims annually, covering the entire United States and territories in 360 geo zip regions. Context also produces our UCR fee schedules in a format fully compliant with the No Surprise Billing Act regulations. Our UCR provide a nationally recognized database of appropriate charges for millions of procedure combinations.

The Context4 Healthcare is a licensed agent of the American Medical Association (AMA), providing data products payers require for claim processing today, including CPT, ICD-10, HCPCS, and CDT. Each of these databases contains descriptions of three different lengths, facilitating understandable EOBs. Context is also a licensed partner of the American Society of Anesthesiologists (ASA), providing many payers with the ASA Crosswalk and Relative Value data products.