Alternatives to PayerPrice

The Turquoise Health Enterprise platform offers a wide-ranging array of solutions centered on healthcare price transparency and the management of contracting processes, featuring modules like Clear Rates Data, which compiles an extensive dataset of over a trillion records related to providers, payers, professionals, drugs, and devices for both institutional and professional services. In addition, it incorporates Clear Contracts, a cloud-based application designed to facilitate the creation, negotiation, and storage of contracts for both payers and providers. This platform also provides Compliance+ to aid organizations in adhering to the requirements for machine-readable files and Good Faith Estimate regulations, along with Analytics tools that allow users to benchmark and investigate market-level rate data. Furthermore, it offers Custom Rates extracts specifically designed for niche healthcare segments, Standard Service Packages comprising pre-assembled bundles of frequently performed procedures, and Search and Care Search dashboards that assist in the discovery and comparison of rates. Additionally, the Turquoise Verified program empowers both providers and payers to efficiently publish and manage their price transparency information, ensuring that all stakeholders benefit from accessible and reliable pricing data.

HexIQ software offers quick and straightforward access to negotiated rate information, enabling users to search, download, and analyze intricate healthcare reimbursement rates associated with any specific code, payer, provider (NPI), or tax identification number (TIN), thereby allowing them to utilize transparency in coverage requirements for better business decisions and negotiations. Each month, it processes numerous machine-readable files (MRFs) from various payers, meticulously cleaning and enriching the data with relevant provider names, addresses, and network affiliations, and continually updating it to enable users to benchmark their negotiated rates against those of peers within the same specialty and geographic area without the need for cumbersome Excel work. The software's sophisticated search capabilities allow users to filter results by criteria such as code, specialty, state, place of service, payer, NPI, or TIN, with the option to download findings in CSV format for deeper analysis. Furthermore, integrated analytics and visualization tools provide insights into rate distributions, average and mode rates, and contracted provider networks, which help users gain a clearer understanding of market dynamics. This comprehensive approach not only streamlines the process but also empowers healthcare professionals to make informed strategic decisions based on reliable data.

Stratasan’s Analytics Platform equips hospital executives and strategic planners with comprehensive and current insights into the healthcare landscape. Rather than spending precious hours sifting through data, you can focus your efforts on crafting effective strategies and making informed decisions. This platform supports high-level strategic conversations, ensuring that all team members are aligned and informed. With a shared understanding of analytics, your team can swiftly make real-time decisions. Create and distribute strategic presentations on market intelligence and key initiatives in mere minutes instead of the weeks it typically takes. Analyze reimbursement rates by payer and track trends across various service lines. Approach negotiations with confidence, advocate for acquisition targets that hold the greatest potential for success, and perform thorough evaluations of the ROI when considering entry into new markets. This streamlined process enhances collaboration and drives better outcomes for your organization.

HRA® (Healthcare Research & Analytics) is a comprehensive market research firm specializing in the healthcare sector, offering exclusive access to a proprietary panel that includes physicians, payers, patients, caregivers, pharmacists, and other essential stakeholders to enhance your brand strategy. With over 100,000 community-based healthcare professionals and influential opinion leaders contributing valuable insights on critical issues, HRA® ensures you receive the information necessary for your success. Drawing on more than 75 years of collective experience in collaboration with healthcare companies, HRA® delivers insights and guidance essential for pre-launch, launch, and post-launch phases. The agency supports your commercial objectives by developing brand strategies, executing them, and providing real-time evaluations of stakeholder attitudes and behaviors. HRA® offers tailored strategic solutions to a diverse range of healthcare clients, combining clinical knowledge with commercial acumen and innovative strategies to keep you at the forefront of the healthcare landscape. Their commitment to understanding the dynamics of the healthcare community positions them as an invaluable partner in navigating industry challenges.

We facilitate the transition to value-based healthcare by evaluating various treatments, medications, processes, and costs, which aids hospitals, life sciences firms, and payers in pinpointing the most effective treatment strategies for optimal patient results. Our CRCA™ P&T platform equips Pharmacy and Therapeutics committees to implement data-driven enhancements in key quality indicators, including metrics like average length of stay (ALOS) and 30-day readmissions. The innovative POP-BUILDER Rx™ solution offers comparative evaluations among chosen cohorts against CRCA’s extensive real-world data index, which encompasses over 140 million longitudinal patient records. Additionally, our drug remittance dashboard provides an in-depth analysis and reporting of drug remittance information across different payer categories, focusing on high-cost medications at the National Drug Code (NDC) level. Furthermore, we assist hospital finance teams in effectively tracking and enhancing service line costs and profitability, productivity, and revenue cycle performance through our insightful analytics, detailed reporting, and the expertise of our Agilum Healthcare Intelligence team. This comprehensive approach ensures that healthcare providers can make informed decisions that positively impact both operational efficiency and patient care.

Medisolv offers a wide range of quality management solutions tailored for healthcare providers, including hospitals and clinicians. Our flagship platform, ENCOR, stands out as an award-winning, all-encompassing quality solution designed to streamline operations. As a dedicated healthcare quality data management firm, Medisolv equips organizations with a comprehensive Quality management software that simplifies core measure abstraction and facilitates electronic measure capture across both hospital and outpatient settings. This software enables effective data aggregation from diverse sources and ensures seamless submission to various reporting entities, such as CMS, TJC, state agencies, payers, and organizations like ACOs. With ENCOR, healthcare facilities gain access to up-to-date eCQM performance data, empowering them to enhance their outcomes while simplifying compliance with regulatory programs. Additionally, ENCOR enhances the chart abstraction process by providing daily updated data and automatically pre-filling patient information, making it easier for hospitals to fulfill their reporting obligations efficiently. Ultimately, our software is crafted to support healthcare institutions in navigating the complexities of quality reporting and achieving their performance goals more effectively.

Established in Chicago, Illinois, PatientIQ provides a platform for healthcare providers, medical device manufacturers, life sciences companies, and payers to enhance their practices through data-driven medicine. It is recognized as the largest collaborative platform for healthcare professionals aimed at improving patient outcomes. By equipping healthcare providers with cutting-edge technology, PatientIQ fosters a culture of data-driven medical practice. In the competitive landscape of the U.S. healthcare market, all parties involved face mounting pressure to demonstrate their value effectively. A key factor in determining "value" lies in the objective measurement of patient outcomes. However, quantifying these outcomes presents challenges that are costly, complex, and fraught with technological obstacles. Despite these difficulties, outcomes represent the most significant currency in the future of value-based healthcare. Thus, a clear and reliable solution to systematically measure, analyze, and benchmark outcomes among various stakeholders presents a significant opportunity for growth in the digital health sector. As the industry evolves, the need for such innovative solutions will only become more pronounced.

Milliman MedInsight® was founded in 1998 and is a leading provider for healthcare data and analytics. Over 300 payers/ACOs/employers and government agencies trust Milliman MedInsight. Our comprehensive suites of analytics and data enable organizations to leverage healthcare information for better clinical and financial outcomes. We deliver actionable insights on healthcare utilization, costs and quality using our deep industry expertise and advanced technologies. Milliman MedInsight empowers stakeholders with the tools they need to navigate the healthcare landscape, from risk management to value-based care.

Anomaly is an innovative AI-driven platform designed for payer management that empowers healthcare revenue teams to understand their payers as thoroughly as those payers understand them. By revealing hidden behaviors of payers through the analysis of intricate rules and payment trends across millions of healthcare interactions, it enhances operational efficiency. Central to this platform is its Smart Response engine, which perpetually scrutinizes payer logic, adjusts to evolving policies, and integrates its insights into current revenue cycle processes, enabling real-time predictions of denials, support in claims adjustments, and alerts regarding potential revenue threats. Users gain the ability to foresee revenue shortfalls, negotiate more effectively with payers, and proactively address or overturn denials, thereby safeguarding cash flow. This advanced system effectively bridges the gap between providers and payers, transforming complex billing frameworks into practical intelligence that informs daily financial management while also fostering an environment of enhanced strategic decision-making for revenue teams. By empowering users with this level of insight, Anomaly not only improves operational outcomes but also contributes to a more equitable balance in the healthcare financial landscape.

The Talix platform facilitates advanced workflow applications designed for risk-bearing healthcare organizations to thrive in a value-based care environment. Our solutions for both payers and providers depend on sophisticated technologies that operate seamlessly and efficiently across large scales. We have developed the Talix Platform to accommodate the requirements of thousands of users globally, ensuring simultaneous access. Additionally, our architectural design supports a variety of SaaS applications, optimizing the processing of millions of patient records and encounter data. The Talix Platform consists of a network of interconnected technology components, which are essential for driving scalable software solutions for healthcare providers and payers. These components serve as foundational elements for artificial intelligence (AI), enhancing the platform's capabilities and effectiveness in the healthcare sector. Ultimately, the integration of these technologies positions the Talix Platform as a leader in the evolution of healthcare workflows.

Sift clarifies the complexities of healthcare payment processes by embedding actionable insights into revenue cycle operations, enabling healthcare organizations to enhance payment results and minimize collection costs. By providing healthcare providers with crucial information on denial management, Sift empowers them to safeguard their receivables and expedite cash inflows. It compiles insurance claims and patient financial information into a secure, HIPAA-compliant, cloud-based database, ensuring a reliable source of information regarding healthcare payments. Furthermore, Sift addresses the disconnects between a provider's electronic health records, clearinghouse, workflow management tools, and patient interaction platforms. By consolidating data from these various sources, Sift creates a distinctive and proprietary dataset that offers comprehensive oversight of payment processes. Utilizing a range of data science methods, Sift delivers thorough and cohesive recommendations for managing denials, evaluating payers, enhancing patient collections, and improving patient acquisition strategies, ultimately leading to better overall financial performance for healthcare practitioners. This innovative approach not only streamlines operations but also fosters a more efficient healthcare payment ecosystem.

LexisNexis® MarketView™ provides medical claims-based insights tailored for healthcare payers, providers, life sciences enterprises, and health IT organizations throughout the United States. This platform offers actionable intelligence designed to enhance competitiveness, enabling businesses to uncover valuable insights and visualize transformative strategies. Regardless of whether you represent a life sciences firm, a health insurance plan, a healthcare system, or a health IT service provider, MarketView can significantly enhance critical business processes such as marketing, sales, strategic planning, physician engagement, outreach, market research, network optimization, talent acquisition, pricing strategies, contracting, and clinical management, among others. To stay ahead in the competitive landscape, your organization requires the most relevant insights available. However, determining the right areas to focus on can be challenging when the overall picture lacks clarity. MarketView addresses this issue by providing insights into various aspects such as referral trends, strategies for aligning with physicians, the performance of clinically integrated networks, and patient volume metrics, ultimately empowering organizations to make informed decisions. By leveraging these insights, businesses can drive innovation and improve their operational effectiveness.

Surpass consumer expectations for care while fostering unprecedented growth and loyalty. Press Ganey's cutting-edge Consumer Experience technology is set to transform patient acquisition, retention, and reputation management within your healthcare organization. The recent acquisition of SPH Analytics (SPH), a frontrunner in measuring and enhancing member experience in the health insurance sector, marks a pivotal moment for Press Ganey. By integrating its premier patient experience data with SPH's comprehensive member experience insights, Press Ganey aims to create a cohesive understanding of provider and payer dynamics, ultimately leading to improved healthcare outcomes. Your dedicated Press Ganey success team will be available to support and guide you at every phase of the journey. Our ongoing commitment to investing in advanced technology and exceptional talent ensures that our clients remain leaders in the healthcare industry, equipped to meet future challenges effectively. Together, we can pave the way for a more integrated and responsive healthcare system.

Combine and liberate your disorganized health information through an interactive AI and NLP solution that provides valuable health insights for various stakeholders. This innovative technology serves Providers by hastening the data abstraction process and ensuring the clinical information validation found within notes, thus minimizing the time and costs associated with identifying care gaps, assessing the quality of care through dashboards, and producing registry reports. For Payers, it facilitates the integration and analysis of claims alongside clinical notes, enhancing the management of high-risk and high-cost member populations. In the realm of Life Sciences, this solution enables swift patient matching to clinical trials using databases alongside clinical note data, maximizing the potential of real-world clinical evidence. Ember offers a comprehensive approach that merges NLP with predictive analytics, streamlining healthcare analytics for unstructured data to boost quality, efficiency, and outcomes in the healthcare system. As a result, stakeholders can make informed decisions that lead to improved patient care and resource allocation.

Enhance your financial performance by centralizing the automation of patient cost estimates, identifying payer underpayment issues, and optimizing contracts all within a single platform. Detect and analyze trends related to insurance company underpayments to ensure your chargemaster is set for maximum efficiency. Delegate investigations and appeals to your team while monitoring their progress seamlessly in one dashboard. Evaluate and compare performance metrics across different payer contracts to negotiate terms more effectively and from a position of strength. Accurately project patient out-of-pocket expenses, instilling confidence for upfront deposits. Facilitate direct online payments for upfront deposits, enhancing patient convenience. Hold insurance providers accountable for the full amounts due, empowering you in contract discussions. Minimize bad debt and reduce the costs associated with collections, while also decreasing the number of days in accounts receivable. This streamlined approach not only improves financial outcomes but also enhances patient satisfaction and trust in your services.

Value-driven care relies heavily on timely, precise, and trustworthy information. Utilize the Minerva Healthcare Data Platform to consolidate both clinical and claims information from various systems into a centralized FHIR® repository. With its foundational design based on FHIR® and a commitment to being vendor-neutral, Minerva compiles data from your care delivery network, facilitating data exchange, enhancing analytical capabilities, and ensuring compliance with Cures Act requirements. The platform offers a suite of ready-to-use data connectors that enable swift data ingestion from diverse clinical and claims sources. Take advantage of established healthcare standards and tailor-made data formats to incorporate information in real-time or through batch processing. By integrating data from your clinical network alongside that from your payers, you can create a comprehensive view of your patients' information, ultimately leading to improved care outcomes. This holistic approach not only streamlines operations but also fosters a deeper understanding of patient needs.

We are entering a transformative phase in predictive analytics, particularly focusing on healthcare data management, through innovative machine learning tools and tailored applications specifically for the healthcare sector. Lumiata’s advanced cost and risk forecasting capabilities consistently surpass traditional techniques, revolutionizing risk management and care delivery within the healthcare landscape. Whether it’s underwriting, care management, or pharmaceuticals, Lumiata provides comprehensive solutions. Our sophisticated applications and data science tools foster an adaptable and cooperative alliance with payers, providers, and digital health entities. Discover the promise of AI innovation with us, as we empower your data science teams with essential ML productivity tools. The journey begins with our unique data preparation and cleansing methodology, where raw data is seamlessly ingested, purified, and structured into an accessible format that is primed for machine learning applications, ensuring that your organization can leverage the full potential of its data.

A versatile business intelligence platform designed to deliver comprehensive analysis of operations, sales, inventory, and more within pharmacy and healthcare organizations. Users can access and query various data sources through a user-friendly, centralized web interface. This innovative technology allows for extensive data queries to be executed in minutes instead of hours, enhancing efficiency. It enables concurrent back-end ETL (extract, transform, load) processes and front-end analytics without interference, streamlining overall operations. As your business evolves, this tool adapts to meet growing computational demands through ongoing enhancements and scalable capabilities. Promoting widespread e-payment acceptance among healthcare payers hinges on strategic planning, expertise, and leading through example. Learn how dialysis centers and other renal care providers can achieve financial sustainability by optimizing their revenue cycles effectively. Furthermore, uncover the compelling evidence that supports transitioning members to digital communication methods for improved engagement and efficiency.

Arrow serves as a platform for managing healthcare revenue cycles, enhancing and simplifying payment processes through the automation of billing, claims processing, and predictive analytics, which aids both providers and payers in alleviating administrative tasks, decreasing denial rates, and expediting collections. By integrating workflows, data, and artificial intelligence, Arrow enables teams to identify claim errors prior to submission, handle denials with comprehensive root-cause analyses and simple corrective actions, while also receiving up-to-the-minute claim status updates directly from payers. The platform effectively streamlines the integration of Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) data into an easily navigable format, offers valuable revenue intelligence with insights that drive improvement in the revenue cycle, and ensures payment accuracy by monitoring for underpayments or overpayments in line with payer contracts. Additionally, Arrow’s innovative features contribute to a more efficient healthcare payment ecosystem, ultimately leading to improved financial outcomes for providers and payers alike.

Aroris360 is a specialized contract management platform tailored for the healthcare sector, aimed at digitizing, organizing, and analyzing payer contracts to enhance revenue insights and operational efficiency. By converting traditional paper agreements into a searchable digital repository, it allows for immediate access to contract details, facilitates side-by-side comparisons, and sends out automated compliance notifications that make the renewal process smoother while bolstering negotiation tactics. This platform consolidates payer contracts, fee schedules, and claims information into a unified system, seamlessly integrating with clearinghouse files to provide real-time payment processing and maintain an extensive claims history. Additionally, Aroris360 offers sophisticated analytics that dissect payer composition, coding practices, and revenue trends, empowering organizations to pinpoint discrepancies between the agreed-upon rates and actual payments, identify instances of underpayment, and reveal avenues for further enhancement. Ultimately, this comprehensive tool not only streamlines contract management but also positions healthcare organizations to achieve better financial outcomes.

Built upon FHIR v4, this solution utilizes native FHIR data models and a RESTful API to ensure compliance with USCDI v1, effectively storing and providing complete USCDI v1 data to both patients and partners. It allows for the secure export of electronic health information, promoting safe access for patients. By integrating your EHR, payer systems, or any health information technology into fhirstation, you can achieve immediate compliance with the Final Rule. Fhirstation serves as a comprehensive, scalable, and secure multi-tenant Software as a Service (SaaS) platform tailored for electronic health record (EHR) vendors, health plans, hospitals, providers, and other organizations that are required to deliver patient data in accordance with the USCDI v1 FHIR v4 API and the electronic health information export mandates of the HHS final rule and CMS interoperability guidelines. This platform effectively dismantles barriers to information sharing by facilitating data exchange among patients, health IT developers, health systems, EHR vendors, and payers. Additionally, fhirstation is designed to be SMART on FHIR ready, paving the way for innovative patient access applications in the future while fostering a collaborative healthcare ecosystem.

Kodiak Platform serves as a comprehensive, cloud-based solution for healthcare finance and revenue-cycle management, aiming to streamline essential financial operations for hospitals, health systems, and physician practices. Central to its offering is the proprietary Revenue Cycle Analytics software, which compiles over twenty years of national payor and provider data to provide profound insights into net revenue trends, competition standards, and potential risk factors, all designed to ensure a significant return on investment. The platform incorporates various modules, including charge capture, three-way cash reconciliation, uncompensated-care reimbursement, and payor market intelligence, which empower finance teams to automate vital processes, enhance visibility into unapplied payments, and assess payor performance at a granular level. Users benefit from detailed dashboards and multi-step workflows that facilitate the standardization of revenue-cycle tasks, minimize manual labor, and uncover new growth opportunities, all from a single, integrated platform instead of disjointed systems. This holistic approach not only boosts operational efficiency but also fosters a more strategic perspective on healthcare finance management.

The Innovaccer Health Cloud will accelerate your transformation. You can unify patient data, create comprehensive financial and clinical insights, and innovate faster. We help providers integrate disparate patient information to provide actionable insights at point of care, collaborate across care teams and achieve better outcomes. We facilitate connectivity and collaboration among payers, providers, members, and members to manage risk and compliance as well as rising member expectations. We assist medtech and biopharma companies to build digital solutions at the intersection of healthcare and better use real-world data throughout the value chain. Transform from silos to an open platform that unifies healthcare data into one longitudinal patient record that allows for whole-person care.

Gigasheet applies AI to healthcare price transparency data to deliver market intelligence for providers, payers, and consultants. The platform structures Transparency in Coverage datasets at scale and analyzes them to benchmark reimbursement rates, identify outliers, and surface opportunities for savings or growth. Organizations can integrate their own claims, contract, or network data within a high-scale spreadsheet-style interface to create a complete view of market dynamics. Gigasheet’s AI agent produces consultant-grade reports, dashboards, and executive summaries, allowing teams to improve contracting and strategy decisions without relying on complex technical workflows.

Our services for Provider Enrollment and Credentialing assist healthcare providers in securing and maintaining their enrollment, ensuring that payers have all necessary information to process claims efficiently. We focus on New Provider Enrollment by fostering relationships with new or previously unengaged payers to enhance revenue potential. Our re-credentialing process addresses the requirements of commercial payers and hospital applications, while our Annual Maintenance services include CAQH Maintenance and Attestation, as well as re-validations for both Medicaid programs and managing expiration dates for DEA, licenses, malpractice insurance, and more. Navigating the complexities of credentialing for your healthcare facility can be a daunting task that consumes significant staff resources. As a comprehensive revenue cycle management firm, we recognize the crucial role that provider credentialing plays in maintaining a healthy cash flow. Our credentialing services cater to both new and existing providers, ensuring that all necessary documentation and relationships are in place for seamless operations. By utilizing our expert services, healthcare practices can focus more on delivering quality care rather than getting bogged down by administrative burdens.

Panalgo’s Instant Health Data platform is an all-encompassing software suite for healthcare analytics designed to simplify programming complexities and expedite the analysis of real-world data across various sectors, including life sciences, pharmaceuticals, payers, providers, government, and academia. This platform assimilates a wide range of health data sources—such as claims, electronic health records, registry information, and other real-world datasets—and transforms them into a cohesive, analysis-ready format using a healthcare-specific data model alongside a rich library of algorithms. This enables fast, scalable, and clear analytics without the conventional barriers of coding. Users can benefit from point-and-click analytics, personalized dashboards, statistical assessments, machine learning predictions, automated documentation, and collaborative reporting, empowering stakeholders to efficiently investigate, interpret, and disseminate insights. Additionally, integrated features like Ella AI offer natural-language, generative-AI support that assists in cohort building, insight generation, and decision-making processes, further enhancing the platform's utility for its users. As a result, Panalgo’s IHD not only streamlines analytics but also fosters a collaborative environment for various healthcare stakeholders.

MedScout stands out as a specialized platform for revenue growth and sales intelligence, tailored for companies in the medical device, diagnostics, and life sciences sectors, with the goal of enhancing the efficiency of their commercial teams in recognizing opportunities and implementing sales strategies within healthcare markets. By converting extensive healthcare claims data into practical insights, it equips sales representatives, marketing personnel, and sales executives to effectively prioritize the most relevant physicians, healthcare facilities, and systems to approach. The platform consolidates various data sources, such as Medicare and commercial payer claims, public healthcare information, proprietary datasets, and the organization's existing CRM data, thereby providing a comprehensive perspective on the healthcare landscape. This unified view allows teams to scrutinize aspects like procedure volumes, diagnostic trends, prescription activity, referral networks, and payer compositions for specific providers or institutions, ultimately leading to more informed decision-making. With MedScout, organizations can not only enhance their targeting strategies but also facilitate better alignment between their sales efforts and the evolving dynamics of the healthcare industry.

We stand out by embracing unconventional ideas. By offering innovative products and resources, we empower our clients to achieve greater outcomes, enhancing their knowledge, providing deeper insights, and driving their success. The evolving landscape of the healthcare sector has compelled payers to adopt more consumer-oriented business strategies, yet many companies find that their traditional data warehouse systems fall short in facilitating this transition. A compelling case study highlights how one payer successfully utilized our solution to monitor medical cost trends and implement pay-for-performance reporting. Expanding beyond their basic claims-processing functions, Health Intelligence Analytics (HIA) uncovered significant savings opportunities that could amount to millions for the organization. Additionally, HIA’s Simple10℠ streamlines all tasks related to the transition from ICD-9 to ICD-10, alleviating conversion worries through its user-friendly pre-built crosswalk, customizable features, and ready-to-use analytics and dashboards. This comprehensive approach not only simplifies the process but also equips healthcare providers with the tools they need to thrive in a competitive market.

The Aetion Evidence Platform® provides essential real-world evidence tailored for life sciences companies, payers, and risk-bearing providers. Our mission is to tackle significant healthcare inquiries: identifying the most effective treatments, determining their ideal patient populations, and establishing the optimal timing for their application. This approach directly translates into improved decision-making. Serving as a collaborator to many of the leading 20 global biopharma companies, prominent payers, and the FDA, Aetion plays a pivotal role in shaping the most vital decisions within the industry. Our transparent analytical methods facilitate advancements in product development, commercialization strategies, and payment innovations, steering healthcare into a new age. By transitioning the use of real-world evidence from merely descriptive analytics to deriving causal insights, the Aetion Evidence Platform is at the forefront of this evolution. Furthermore, we provide timely answers within a matter of days or weeks, delivering the swift results necessary to enhance both clinical and financial outcomes. Make the most of your available data by transforming it into actionable insights that can be utilized immediately for better healthcare solutions.

Valer’s innovative technology streamlines and accelerates the processes of prior authorization and referral management by facilitating automated submissions, status checks, verifications, reporting, and EHR synchronization, all from a single platform that caters to mid-to-large-sized healthcare facilities, various specialties, and multiple payers. Designed to meet the specific needs of users, Valer stands out as a comprehensive solution that accommodates all specialties and payers, in contrast to generic products that often restrict specialties and service lines and lack automation for submissions. The platform's user-friendly interface boosts staff productivity, simplifies the training process, and monitors both staff and payer performance across diverse service lines, fostering an environment of ongoing enhancement. Valer goes beyond merely connecting with a handful of payers; it integrates seamlessly with all payers, ensuring compatibility across all specialties, service lines, and care environments, and provides real-time updates on payer rules to keep your operations current. With Valer, healthcare organizations can experience a revolutionary shift in how they manage prior authorizations and referrals, paving the way for improved efficiency and patient care outcomes.

HealthNexus is at the forefront of transforming healthcare through groundbreaking innovations. Our platform is designed to be medically proficient, ensuring that all pertinent information is considered and utilized. Experience reliable results delivered more swiftly and at a lower cost. With access to billions of meticulously organized and integrated data points, we provide profound and accurate real-world insights and outcomes for patients, providers, and payers alike. This encompasses a range of elements, including social determinants of health (SDOH) for patients and providers, Risk Adjustment Factors (RAF), Hierarchical Condition Categories (HCC), and associated quality scores. You can easily generate a variety of detailed reports, ranging from standard templates to tailored complex queries, enhancing your ability to uncover insights throughout the healthcare landscape. Our collaboration with PurpleLab facilitates access to an extensive array of medical terminology and concept groups, empowering you to effectively oversee and manage your organization's medical terminology reference data. This comprehensive approach ensures that you remain informed and equipped to make data-driven decisions in an ever-evolving healthcare environment.

Enhance clinical results and reduce complication rates by collaborating with our expert team and utilizing a comprehensive consultative method. Hospitals, clinical leaders, and their teams have consistently prioritized improving patient outcomes, and the demand for high-quality care is more pronounced today among patients, employers, and payers alike. This growing emphasis on quality necessitates that hospitals remain vigilant about their quality metrics and maintain transparency with the public. Healthgrades offers valuable resources to assist hospitals in their ongoing quest to measure and enhance quality outcomes effectively. The dedicated Healthgrades Quality team partners with hospitals to delve into the reasons behind their performance levels, helping them identify improvement opportunities and establish priorities for their enhancement initiatives. Additionally, our team conducts a thorough comparative analysis with clients, assessing their performance against leading hospitals and both local and national competitors to foster better outcomes. This proactive approach not only aids in immediate improvements but also cultivates a culture of continuous quality advancement in healthcare settings.

Flexpa is an innovative tool designed for healthcare data interoperability, providing developers and organizations with quick access to extensive health records through a unified API, contingent on patient consent. By utilizing FHIR (Fast Healthcare Interoperability Resources) standards and integrating a 3-in-1 network comprising CMS-9115 payer APIs, ONC (g) (10) provider APIs, and TEFCA IAS nationwide exchange support, it effectively streamlines the traditionally slow and manual record collection process into real-time, standardized data retrieval. Moreover, Flexpa manages the complete authentication and authorization process, which includes digital consent workflows, SMART Health Links, IAL2 identity verification, and a user experience optimized for conversion, allowing applications to onboard patients, obtain compliant consent, and swiftly access data without the need for custom integrations. Additionally, Flexpa’s Records API is adept at extracting and enhancing full patient data, which encompasses claims history, clinical records, and more, thereby enabling healthcare organizations to operate more efficiently and improve patient care outcomes. This comprehensive approach not only simplifies the data retrieval process but also empowers healthcare providers with the tools necessary to deliver timely and informed care based on the most current patient information.

We assess health beyond traditional healthcare environments to gain a deeper insight into the burden of diseases. This holistic perspective on patient wellness reveals new business avenues by introducing innovative metrics for understanding disease and patient health. By cultivating a patient-focused comprehension of how diseases affect daily functioning, we can engage both physicians and payers more effectively while enhancing patient support initiatives. Furthermore, we aim to develop sophisticated algorithms that can forecast disease onset and its progression or regression, as well as pinpoint critical moments for intervention. Utilize actual digital data to advocate for the advantages of your offerings. Our technology-driven service facilitates real-world research that integrates unique, day-to-day behavioral information, thereby benefiting clinical, medical affairs, and commercial divisions, all while utilizing Evidation's virtual research site, Achievement. With adaptable study designs, strategies for device integration, and streamlined protocol management, we ensure efficient study operations. Additionally, we offer the flexibility for sponsorship either by us or your organization, allowing for tailored collaboration.

Reduce expenses, break down data silos, and enhance outcomes for your members with a cohesive, automated provider data solution. symplr Payer serves as a reliable single source of truth for provider data, ensuring it is regularly reconciled and verified against primary sources. This solution significantly boosts data quality, accessibility, and transparency. Additionally, it alleviates provider frustrations by eliminating redundant requests for information. By utilizing symplr Payer as the central hub for provider data across the enterprise, payers can disseminate timely and precise information to various downstream systems. Our comprehensive and adaptable provider data management solution oversees all pre-contract and renewal contract negotiations. You can streamline and standardize your contracting workflows while meticulously capturing contract specifics such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule information, and more. Furthermore, symplr Payer's innovative design enables your organization to effectively merge contracting and credentialing processes into one seamless operation. This integration not only simplifies management but also enhances overall efficiency in handling provider data.

Enhancing your care quality and increasing referrals can be achieved more effectively through innovative strategies. With the implementation of Value-Based Purchasing (VBP) and the recent Patient-Driven Payment Model (PDPM), having access to actionable and up-to-date performance data for Skilled Nursing Facilities (SNFs) has become crucial. This data plays a vital role in reducing readmission rates, elevating care quality, showcasing value to referral partners and payers, managing high-risk residents efficiently, and successfully navigating the complexities of PDPM and VBP. SHP for Skilled Nursing is a comprehensive web-based program dedicated to performance improvement, allowing you to take a proactive approach in managing readmissions, enhancing functional outcomes, optimizing staff resources, and strengthening your relationships with referral partners and payers alike. By utilizing Strategic Healthcare Programs, healthcare facilities such as home health agencies, hospices, skilled nursing facilities, and hospitals can enhance quality and optimize their overall performance through the provision of real-time actionable analytics, benchmarks, and user-friendly dashboards. This holistic approach not only improves patient care but also fosters better collaboration with referral sources and payers.

Greenway aims to transform healthcare by providing top-notch solutions tailored for practices, patients, and communities alike. Their comprehensive, interoperable software platform is designed to meet the diverse needs of ambulatory care specialties while ensuring a superior client service experience. A dedicated team composed of clinical, financial, and technological experts is committed to offering solutions that empower clients to thrive in the dynamic healthcare environment. By prioritizing emerging client needs and integrating direct feedback, they continuously enhance provider experiences with innovative products and services. Their medical software for ambulatory practices is both reliable and user-friendly, promoting efficiency and ease of use. Adopting a client-centered approach, they offer a versatile suite of data-driven EHR, practice management, and revenue cycle solutions to help practices navigate industry shifts effectively. Greenway's commitment to integrating end-to-end EHR, practice management, and medical billing systems further establishes them as a leader in the healthcare technology sector. This holistic approach ensures that practices not only keep pace with changes but also excel in providing quality care.

Leveraging AI as a foundational strategy for payers, providers, and pharmacy benefit managers involves developing cloud-based products and platforms that enhance operational efficiency. A "healthcare digital platform" represents the amalgamation of various applications and cutting-edge technologies to deliver customized healthcare solutions that positively influence business results, marking a progressive and expedited shift away from traditional core administration processing systems (CAPS). To gain insights into how digital platforms and emerging technologies can help meet business goals, as well as their effects on healthcare payer key performance indicators (KPIs) and the overall appeal of these platforms, Infosys collaborated with HFS to survey 100 C-suite healthcare payer executives across the United States. This initiative aims to shed light on the evolving landscape of digital healthcare solutions and their potential for transforming industry practices.

CareJourney is an advanced healthcare analytics platform hosted in the cloud, providing extensive and clinically relevant insights derived from one of the largest longitudinal claims datasets in the United States, encompassing hundreds of millions of beneficiaries from Medicare, Medicaid, Medicare Advantage, and commercial sectors, while also profiling over 2 million healthcare providers. This platform enables organizations to evaluate markets and patient groups to discover opportunities for cost efficiency and improved health outcomes, facilitate the development and enhancement of high-performing networks, make informed contracting choices, identify referral trends and service leakage, and compare provider performance with that of their peers. Moreover, it aids in managing at-risk populations by utilizing segmentation models that allow organizations to gain valuable insights into the prevalence of chronic conditions, patterns of care utilization, and the factors driving costs. The comprehensive data analysis provided by CareJourney ultimately supports organizations in achieving their healthcare goals more effectively.

Enter gets Providers (doctors and practices & hospitals) paid faster that anyone in history. Enter processes insurance claims and pays within 24 hours. It also automatically communicates and collects patient responsibility using a white label collection engine that includes payment plans. Enter is 30x more efficient at getting claims paid, and 45x quicker at getting patients billed at the exact same cost as existing medical billers. In just one year, we processed over $150 million in claims. Providers have access to a $100mm credit facility. United Healthcare Nevada - Revenue Cycle Management Partner Enter supports a wide range of specialties, including ASC, Orthopedics and Neurology, Dermatology. Emergency Rooms, Behavioral Healthcare, Pain Management, and many more. - Enter works with all government and commercial health insurance carriers. - Enter integrates all EMR/practice management systems. No monthly fees No integration fees. Venture backed by Enter

The healthcare sector is filled with a myriad of opportunities, risks, and challenges, ranging from medical device sales to integrated delivery networks and evolving care trends. For businesses aiming to thrive in this competitive market, possessing accurate data intelligence and insights is crucial. MCH offers updated and cost-effective healthcare data resources that equip you with the necessary tools for your upcoming sales initiatives, allowing for extensive and detailed searches like never before. Our comprehensive healthcare database features over 2 million contacts sourced from top industry authorities, enabling you to investigate corporate ownership, provider specialties, and a broadened array of care facilities, laboratories, and other health organizations with ease. You can meticulously filter your searches by institution type, professions, and specialties across more than 7,000 hospitals throughout the country, while also examining vital statistics such as the current number of beds, physicians, and other healthcare providers. This advanced capability in data analysis ensures that you are well-prepared to make informed decisions that can propel your business forward in the ever-evolving healthcare landscape.

SKYGEN's Provider Data Management (PDM) is a responsive solution designed to enhance the management of provider networks and foster better relationships between healthcare payers and providers. This platform not only boosts the capacity of payers to construct effective provider networks but also elevates satisfaction levels for both providers and members while reducing administrative expenses. By leveraging cutting-edge technology, PDM addresses the demands of contemporary, tech-savvy healthcare participants. It streamlines contract acquisition costs through swift, efficient, and paperless provider recruitment and supplemental network rentals. Additionally, the solution lowers credentialing costs and enhances provider satisfaction by facilitating online credentialing processes. By automating provider self-verification, it eliminates costly outreach efforts and ensures that provider data remains accurate and verified for online directories. Ultimately, SKYGEN enables dental and vision connectivity solutions that empower clients to embrace the future with confidence, utilizing technology that fosters unmatched efficiencies and effectiveness in their operations. This innovation positions healthcare organizations to thrive in an ever-evolving landscape.

MMIT (Managed Markets Insight & Technology) provides a robust analytics and healthcare market access platform that consolidates critical data regarding coverage, policy, restrictions, payers, and real-world insights, enabling life sciences and healthcare organizations to navigate the complexities of therapy coverage, reimbursement, and accessibility within the U.S. healthcare landscape. The MMIT Platform acts as a comprehensive resource where users can delve into a variety of integrated solutions, such as formulary intelligence, medical policy insights, payer landscape and enrollment information, tools for coverage searches, API connectivity, and analytics tailored to support commercialization efforts, competitive assessments, and strategies for patient access. Additionally, it offers in-depth analysis of drug coverage statuses, restrictions, payer dynamics, and market segmentation, featuring tools designed to assess patient access hurdles, guide field engagement initiatives, anticipate policy changes, and seamlessly incorporate coverage information. Ultimately, MMIT empowers its users to make informed decisions that enhance their strategic objectives in the healthcare sector.

CORTEX represents a groundbreaking advancement in utilization management software, delivering a comprehensive 360° solution to navigate the complexities of utilization management and revenue cycle operations. Powered by an advanced machine learning engine and real-time predictive analytics, CORTEX guarantees that cases are addressed promptly and appropriately, whether by the right personnel or through exceptions. By integrating precision medicine with a robust foundation of evidence-based practices, CORTEX enhances the evaluation of patient populations through real-time machine learning models. Our analytics solutions have been successfully implemented in hospitals and health plans nationwide, demonstrating their effectiveness. For straightforward inpatient cases, CORTEX streamlines the process by automating determinations based on your specific criteria, significantly reducing the burden on staff. In contrast, when facing challenging cases, CORTEX equips your team with critical insights to facilitate well-informed decisions. This innovative approach delivers tremendous benefits to both payers and providers, fostering improved healthcare outcomes and operational efficiency. Furthermore, CORTEX's adaptability allows it to evolve with the changing needs of the healthcare landscape, ensuring sustained value over time.

Our goal is to enhance the availability and accessibility of behavioral health services. At Camber, we create innovative software tailored for behavioral health professionals, aimed at elevating the standard of care they provide. We eliminate tedious manual processes, allowing clinicians to dedicate their time and expertise to patient care. Camber's platform is specifically crafted to optimize administrative functions for behavioral health practitioners, which helps them concentrate on delivering exceptional care. It automates essential tasks like daily claim validations and submissions, incorporating features for pre-submission error detection and payer-specific formatting to boost both accuracy and efficiency. By utilizing AI-based workflows, Camber has achieved impressive first-pass collection rates nearing 93%, leading to marked improvements in financial results for healthcare providers. Furthermore, the platform provides valuable data-driven insights that assist clinics in pinpointing ideal areas for growth while also aiding in negotiations with payors. This comprehensive approach not only enhances operational efficiency but also supports clinicians in their mission to deliver better care.