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 Intelligent Data Hub and provides the agile and innovative foundation to deliver value to key data owners, consumers, and decision makers.

Health:iDM for Health Plans & Payers

Build a foundation for analytics that honors your governance needs

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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

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Identify duplication, overpayments, fraud, or abuse by tracking linkages between members, providers, and claims and clearer relationships between subscribers and dependents

Streamlined Processes

Understand provider hierarchies, credentials, and network status to simplify provider verification while easing compliance with regulations such as the No Surprises Act

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Enable real-time and predictive analytics built on high-quality data to support decisions, workflows, and cost forecasting. Generate performance scorecards for bundled payments

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Support multi-vector MDM to leverage unique implementation styles for both operational and analytical use cases

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

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Members and dependents in household – locations, contact information and links to PCPs

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Provider credentials, sanctions, network status, and privileges

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Procedure, diagnosis and condition codes validation

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Member and provider identification/ reconciliation on claims

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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.

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Optimized for payers, creating a golden view of members, their households (subscribers and dependents), and providers that can be shared with enterprise analytics

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Intelligent cross-departmental workflows to identify and correct data issues as soon as they’re identified, including duplicate claims remediation

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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

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Robust reference data management and enrichment to improve data quality while leveraging provider data, credentials, sanctions, and other complementary information

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Expanded access to data for compliance with anti-information blocking and access mandates for health plans both public and private

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