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What is Context 4 Health Plans Suite?

Ensure the dependability of your health plan while identifying precise pricing through the Context4 Health Plans Suite, our adaptable and cloud-based technological solution. Gain immediate and actionable insights for identifying Fraud, Waste, and Abuse (FWA), crafted by our team of certified experts proficient in clinical, dental, and health benefits. By utilizing reliable data along with cutting-edge cloud technology, we provide a strong and justifiable Medicare reference-based pricing (RBP) solution. Our platform integrates over 100 healthcare data sets, further enhanced by expert guidance to improve operational efficiency and maintain regulatory compliance. Moreover, our advanced medical coding software is designed to facilitate claim submissions and minimize the chances of denials. In addition, our cloud-based Payment Integrity Platform employs a distinctive analytics engine to detect coding errors, evaluate medical necessity, tackle unbundling, and identify fraud, waste, and abuse, while also assessing audit risks and uncovering pricing inconsistencies that could greatly impact your organization’s overall performance. This all-encompassing strategy not only protects your financial stability but also equips you for lasting success in the dynamic healthcare environment. With our commitment to innovation, you can navigate challenges with confidence and ensure a future of continued growth.

What is ClaimScore?

ClaimScore is the only independent software solution dedicated to addressing the increasing problem of claim fraud in class action settlements. Each claim undergoes a detailed evaluation on an individual level using our distinctive AI, ML, and Cloud Architecture, with outcomes presented immediately on an interactive dashboard. At the outset, every claim is assigned a ClaimScore of 1,000, which decreases whenever it fails to meet certain criteria. These criteria are assigned fixed or variable weights, reflecting their correlation with fraudulent or legitimate claims. To promote transparency, each claim includes deduction codes that align with the criteria that were not met, making sure that all parties involved, such as the administrator and the court, are well-informed about the exact reasons for any claim denial. This comprehensive method not only builds trust among stakeholders but also strengthens the credibility of the claims process, ultimately contributing to a more reliable settlement environment. By leveraging advanced technology in this manner, ClaimScore ensures a rigorous defense against fraudulent activities.

Media

Media

Integrations Supported

Virtual Benefits Administrator (VBA)

Integrations Supported

Virtual Benefits Administrator (VBA)

API Availability

Has API

API Availability

Has API

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Company Facts

Organization Name

Context4 Healthcare

Date Founded

1988

Company Location

United States

Company Website

www.context4healthcare.com

Company Facts

Organization Name

ClaimScore

Date Founded

2022

Company Location

United States

Company Website

www.claimscore.ai

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

Insurance Claims Management

CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting

Categories and Features

Insurance Claims Management

CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting

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