Health Plans
& Payers
Streamline data exchange and analytics with high-quality trusted member, provider, and claims data
With trusted data, you can improve member engagement and provider satisfaction — while preventing surprise billing events across all encounters.
Proven in Health Plans
For 30+ years, we have helped manage data throughout the healthcare ecosystem. Today, we help health plans gain a single view of members across all encounters and providers. By linking members, dependents, households, providers, and claims, you can improve claims reconciliation, identify fraud and abuse, and empower enterprise analytics.
Improve claims handling efficiency
Understand connections between members and providers
Improve engagement through analytics
Accurately verify members and providers to speed up claims reconciliation, and handling. As regulations and reporting requirements evolve, seamlessly adjust your data collection, verification and sharing practices
Gain insight into relationships of every type: between members and households, subscribers and dependents, and model complex provider network structures to streamline billing, verify network status, and detect potential fraud or abuse
A single, trusted view gives you trustworthy data to support predictive analytics, automated decisions, and agile workflows — providing a foundation to streamline services, forecast utilization, and improve the member experience
Our Approach
Our Health Plan Solutions help you understand the connections between providers, members, and claims. Our solutions include advanced analytics, workflows, and flexible applications so you can:
Gain a single, 360° view of the member and their household across all healthcare encounters and providers
Clarify relationships between members and households, and subscribers/dependents
Verify provider business status such as credentials, hierarchical affiliations, and network status
Expand data access for members with industry-standard APIs and integration to both member and provider data
Identify linkages between members, providers, and claims to identify fraud, abuse, or overpayments
Ensure compliance with the No Surprises Act with data quality measurement and analytics for provider data currency
Leverage reference data management and data enrichment against transactional data as it arrives to limit downstream data errors in business-critical systems
Our Solutions
HEALTH:IDM FOR HEALTH PLANS
Health:iDM for Health Plans is a next-generation, intelligent multi-domain data management platform that enables you to rapidly develop applications and dashboards that connect stakeholders across your organization.
Health:iDM is optimized for health plan data domains, relationships, and workflows that empower and streamline data exchange, internal processing, and trusted analytics, with a multi-vector hybrid architecture that supports both transactional and analytics data in the same platform.
MASTER:ID
Master:ID is a foundational component to your overall data fabric. Built upon the gold standard for person identity matching, linking, resolution, and relationships, Master:ID helps you resolve both member and provider identities no matter where in your system they present, and create a 360° view of all linked source system records with detailed linkage history.
How We Help
Advisory Services
Our proven methodologies, paired with our expert staff and industry leading tools can help you take your data to the next level. Whether you need help streamlining processes, improving workflows, or managing privacy, we can help your entire organization work more efficiently.
Implementation Services
We provide a full range of implementation services, from helping you create a strategy/roadmap to full deployment and 24×7 support of your solution. And we live by our values: “we deliver — no excuses.”
Managed Services
We work the way you do, combining our proven best practices with the agility to adapt to your needs. Whether on-premise, Cloud, or hybrid, we offer the most comprehensive application management services in the industry.
Get Started
Ready to learn more? Find out how we can help you take the next steps in your digital transformation.
Schedule a call
