Real-time pricing during claim adjudication allows payors to become more powerful in the Real-time Health System
, (September 18, 2017) – Virtual Benefits Administrator and Context4 Healthcare, Inc. are pleased to announce the release of real-time Medicare + UCR pricing. This latest addition expands VBA’s process automation in Real-Time Claims Payment (RTCP).
Available to VBA clients today, this solution provides real-time Medicare prospective payment system (PPS) pricing during claims processing. Direct PPS pricing ensures compliance with the Centers for Medicare and Medicaid Services (CMS). It eliminates complexity and the need to utilize less accurate substitutes like RBRVS.
The real-time Medicare pricing feature eliminates wasteful, manual processes that drive cost and human error. Automated NPI to CCN reconciliation significantly simplifies institutional pricing. Built in PPS intelligence automatically chooses which of the 16 PPS best fits each and every line in a claim without human intervention.
The Medicare solution also integrates Context4 Healthcare’s industry-leading Usual, Customary & Reasonable (UCR) fee data. This ensures VBA clients have Medicare gap fill pricing for the ~800 procedures not priced by CMS. This comprehensive solution is one of a kind in the health payer industry.
David Lung, VP at Context4 Healthcare, stated: “VBA is known for innovation in employee benefit administration. Medicare pricing is complex and time consuming. Context is proud to be a part of this advancement in automation and payer value.”
Tom Witter, President of Virtual Benefits Administrator, stated: “VBA is deeply committed to process automation that drives ROI. Real-time Medicare pricing expands our relationship beyond advanced claims editing with Context. It illustrates our agility in integrating best of breed features to maximize value for our customers.”
About VBA. Headquartered in Germantown, WI, VBA has over 20 years of experience in software development for health benefits administration. Our mission of providing Flexibility, Functionality, and Technology for our clients’ business solutions ensures they will optimize their daily business processes and deliver the highest level of customer satisfaction. www.vbasoftware.com. For more information, call (414) 946-1210.
About Context4 Healthcare, Inc. Headquartered in Naperville, IL, Context4 Healthcare has nearly 30 years of experience in software and data product development. Context is a leading provider of cloud based healthcare compliance and payment integrity solutions. These solutions serve hundreds of payer and provider clients, positively impacting millions of lives globally. www.context4.com.