/ Solutions / Payers and TPAs
ContextBase for payers and TPAs
Answers and agents that check every claim, member, and contract against what your team knows, on the systems your plan already runs.
In production with a large national payer, a regional health plan, a PBM, and a large TPA
- HITRUST i1
- SOC 2 Type 2
- HIPAA · BAA
Caught the copay defect review missed.
Large national payer · Impact study →Payers and TPAs
See plans, payments, and care together
Plan design, payment integrity, cost of care, risk adjustment, network, utilization, and member experience, worked from one knowledge graph your team approves.
01Ask
See where payments go wrong
Ask by claim, contract, or provider, or start from the Value Lab library. Every answer arrives with its checks.
02Act
Turn the answer into a routine
A bot reruns the check on a schedule and reports where your team works. Read-only by default.
Connected use cases
Demo data
01 / 07
Plan design and benefits
See how much of the book is custom, match each custom plan to its closest standard plan, and move it at renewal.
- Reads
- plans · benefits · pharmacy benefits
- From
- benefit configuration · claims warehouse
- Delivers
- a migration plan per group
Bring the question your plan cannot answer today.
01Pick the question
Choose one question and the systems that answer it, with our team.
02Connect one system
Connected and mapped in days. Access is approved and time-limited, and every query lands on the audit trail.
03Check the answer
The answer arrives with its queries, rows, and checks. Your team can test it against the source.
Questions plans bring first
Which claims passed every edit and still paid above contract?
Payment integrityWhich members kept paying past the out-of-pocket max?
Plan design and benefitsWhere is PMPM rising because of site of care?
Cost of careWhich diagnoses have no supporting encounter?
Risk adjustmentWhich plans could merge without narrowing a network?
Network and contractsWhich stored procedures change our accumulators?
Knowledge graph
Security
Built to pass your security review
HITRUST i1 and SOC 2 Type 2
Audited every year. The certification letter is public, and reports are available on request.
HIPAA, with a BAA
An annual HIPAA audit, role-based access, multi-factor authentication on privileged accounts, and a BAA we sign.
Approved, time-limited access
Access to data is requested with a reason, approved for a set window, and ends on its own. Every query lands on the audit trail.
Never trains a model
Your claims and member data never train a model, and nothing you send is kept at the model layer.
Questions
What teams ask before they start
Does our member data leave our control?
ContextBase reads your systems where they sit, over the private route your network team picks, through the grants you set. Your data stays with you, in your own cloud storage or in Google Cloud. PHI protections are set per deployment, and we sign a BAA. Every query is logged with the person or bot that ran it.
How long before our teams get a first answer?
Connecting a system takes from 1 to 2 days for IP allowlisting to 1 to 2 weeks for a site-to-site VPN, depending on the route your team picks. Once it is connected, its first scan completes within hours.
Does it replace our claims system or BI tools?
No. ContextBase reads QNXT, Facets, HealthEdge, your warehouse, and your BI where they are, and works alongside them. Dashboards you build in ContextBase refresh without spending tokens.
Who defines what a metric like PMPM means?
Your team. Definitions are approved by the people who own them and versioned in the knowledge graph, and every answer and agent uses the approved one.
Can our consultants work in it?
Yes, inside the same controls, on approved access, with every query on the audit trail. ContextBase for consultants