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:iDM^TM for Health Plans & Payers is built on the Semarchy xDM^TM Unified Data Platform and provides the agile and innovative foundation to deliver value to key data owners, consumers, and decision makers.

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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

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Integrations to dozens of clinical systems

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

When the Centers for Medicare and Medicaid Services reviewed 5,602 providers at 10,504 locations, they found nearly half of provider directory locations had at least one inaccuracy.”

– CMS Online Provider Directory Review Report, 2018

In a typical year, 20-30% of physicians change affiliations and 5% change status (retire, lose their license, pass away, or receive sanctions). That makes directory maintenance difficult — but essential.”

– IDC Health Report, 2016

IMT helps us uniquely identify entities and share that information with those people that need it. A whole bunch of different stakeholders actually access the data right now rather than storing their own data sources that are duplicated all over the place.”

– IMT Client