Health:iDM for Health Plans & Payers
Intelligent Data Management Critical to Member Engagement and Outcomes
Deliver a single view that links members, providers, and claims — empowering predictive analytics, automated workflows, and streamlined claims processing.
IMT Health:iDMTM for Health Plans & Payers is built on the Semarchy xDMTM Unified Data Platform and provides the agile and innovative foundation to deliver value to key data owners, consumers, and decision makers.
Build a foundation for analytics that honors your governance needs
Streamline claims operations with a single view of each member across all encounters and providers. Reconcile claims data faster by integrating claims and clinical data
Identify duplication, overpayments, fraud, or abuse by tracking linkages between members, providers, and claims and clearer relationships between subscribers and dependents
Understand provider hierarchies, credentials, and network status to simplify provider verification while easing compliance with regulations such as the No Surprises Act
Enable real-time and predictive analytics built on high-quality data to support decisions, workflows, and cost forecasting. Generate performance scorecards for bundled payments
Support multi-vector MDM to leverage unique implementation styles for both operational and analytical use cases
Ease integration and payer-to-payer data exchange to comply with the Information Blocking Provider Directory requirements
An intelligent data management platform to
deliver more accurate claims data
Members and dependents in household – locations, contact information and links to PCPs
Provider credentials, sanctions, network status, and privileges
Procedure, diagnosis and condition codes validation
Member and provider identification/ reconciliation on claims
Simplify regulatory compliance
Health plans must navigate an ever-changing regulatory environment. IMT Health:iDM streamlines your provider data management, giving you a complete view that supports analytics and compliance with the evolving regulatory landscape, including:
No Surprises Act: Health plans and providers must ensure providers’ in-network status is up to date within days — or cover any “surprise” bills at in-network rates.
CMS Rule for Information Blocking: Payers both public and private must offer FHIR API access to their provider directory to facilitate accurate data exchange across organizations.
Telehealth Licensing: Health plans that began tracking cross-state licensing for telehealth providers during the COVID-19 pandemic must stay current with shifting regulations and waiver expirations.
Health:iDM for Health Plans & Payers gives you a trusted 360° view of members, households, providers, and claims that supports advanced analytics and streamlined operations.
Optimized for payers, creating a golden view of members, their households (subscribers and dependents), and providers that can be shared with enterprise analytics
Intelligent cross-departmental workflows to identify and correct data issues as soon as they’re identified, including duplicate claims remediation
Centralized codelist management and validation for procedures, diagnosis, and conditions lists, plus an enterprise business glossary and data dictionary for data elements shared across claims processing
Robust reference data management and enrichment to improve data quality while leveraging provider data, credentials, sanctions, and other complementary information
Expanded access to data for compliance with anti-information blocking and access mandates for health plans both public and private
Essential Intelligent Governance and Stewardship for Healthcare Data
Listen to our Podcast on Essential Governance and Stewardship for Healthcare Data
Four Things to Expect from your Healthcare Master Data Management Partner
Key Expectations You Must Have For Your Healthcare MDM Partner
Health:iDM – Intelligent Health Data Management Platform
Health:iDM is the Comprehensive Platform for MDM, Governance, Reference Data and Analytics for Healthcare
IMT Health:iDM For Provider Data Management
Health:iDM for Provider Data Management delivers the robust all-in one platform you need for today’s provider data complexities and opportunities.
New Priorities for Provider Data Management
Modern provider data management requires expanded capabilities and collaboration
Ready to learn more? Find out how we can help you take the next steps in your digital transformation.