Payor

Our solutions are tailor-made for healthcare payors, offering targeted actions through a potent blend of population health data and cutting-edge analytics. We empower payors to enhance population health management, efficiently detect and prevent fraud, streamline claims processing, and integrate value-based care practices. Our offerings deliver quantifiable benefits, including improved cost containment, fraud detection, compliance, revenue optimization, and streamlined regulatory reporting. By partnering with us, payors can ensure accurate, timely reporting, reduce unnecessary claims, and manage the challenges of value-based care effectively, ultimately improving patient outcomes and the bottom line.

Value and Benefits

Improved population health management

Reduced manual intervention to review paper EOBs

Fraudulent claim detection

Identification and reduction of non-medical necessary claims

Manage claim denial and delays

Tracking of medical economics KPIs

Cost containment by value-based care reporting

Improved revenue recognition

On-time submission of regulatory reports

Industry Use Cases

Innovating Healthcare Payor Operations with Advanced Solutions

Advanced Fraud Detection & Prevention

Implement advanced analytics and machine learning algorithms to proactively detect and prevent fraudulent activities, safeguarding payors from financial losses and maintaining the integrity of their systems.

Value-Based Care Integration

Seamlessly integrate value-based care practices into existing systems, enabling payors to optimize care delivery, improve patient outcomes, and align reimbursement with quality metrics.

Provider Network Management

Streamline provider network management processes by leveraging data-driven insights to optimize network performance, enhance provider relationships, and ensure network adequacy.

Claims Processing Automation

Automate claims processing workflows using intelligent automation technologies, reducing manual errors, accelerating claims adjudication, and improving operational efficiency for payors.

Service Offerings

Employ advanced analytics and RAF methodologies to optimize risk adjustment, ensuring accurate reimbursement and improved financial performance for healthcare payors.

Cost Containment Using RAF (Risk Adjustment Factor)

Deploy sophisticated FWA detection algorithms to identify and mitigate fraudulent activities, ensuring compliance with regulatory standards and protecting the integrity of payer systems.

Fraud, Waste & Abuse (FWA) for Compliance

Leverage comprehensive population health data to manage chronic conditions, address behavioral health needs, and report on Social Determinants of Health (SDoH), enhancing care quality and patient outcomes.

Population Health Management & SDoH Reporting

Automate the generation of regulatory reports, ensuring timely and accurate submission to regulatory authorities, and maintaining compliance with healthcare regulations.

Optimize revenue streams by leveraging data analytics to identify opportunities for revenue enhancement, reduce inefficiencies, and maximize financial performance.

Provide detailed medical economics reports to enable informed decision-making, optimize resource allocation, and drive operational efficiency in healthcare payer organizations.

Implement robust denial management strategies and tools to minimize claim denials, improve cash flow, and enhance payer-provider relationships.

Deliver comprehensive operations reports tailored to value-based care models, enabling payers to track performance metrics, monitor outcomes, and drive continuous improvement in care delivery.