Healthcare Payers

Healthcare payer organizations are focused on managing the gap between funding and medical costs, often in the context of a changing regulatory environment. The corporate leaders of health care intermediaries are facing more challenges than ever before driven by a number of factors: government regulations, Medicare/Medicaid reform, social media, rapid technology advances, and cultural change as we move towards a shared risk model.

Customers are becoming truly multi-channel and multi-dimensional and want to interact with their payers seamlessly, real-time and through various methods including web, text, email, web and social media. To survive and flourish, healthcare payers must redefine themselves to meet the demand for a flexible, nimble and responsive organization.

We provide effective solutions to these challenges that are tailored to local health-care systems, and payer organizations. We work with companies to find the best ways to influence the evolution of their processes and systems.

Our Services include:

  • Regulatory Services (ICD-10, HIPAA, OP Rules, 5010, etc.)
  • Insurance Exchanges
  • Project Management
  • EDI/e-Commerce Messaging and Data Transformation
  • Eligibility, Claims, and Payment Management
  • Data Conversion
  • Configuration Design and Build
  • Test, QA, Training and Claims Adjudication
  • Architecture and Systems Selection
  • Interface Design and Development
  • Custom Software Design and Development

Our deep experience in the healthcare industry extends to having a practice dedicated specifically to payers and providers. Our collaborative network of professionals allows us to share relevant expertise that can benefit organizations involved in the financing, management, and delivery of healthcare services.

Our consultants are deeply experienced in a number of payer applications including:

  • Trizetto
  • AMISYS Advance, AMISYS 3000
  • PowerMHS, PowerSTEPP, PowerChoice
  • Diamond and PERADAIGM
  • Xpress, Connnect
  • Metavance
  • EHealthsuite, HealthEdge
  • HealthRules
  • ikaSystems
  • Mckesson
  • Plexis Claim Manager
  • mPhasism HP, Ebix
  • EZ-CAP
  • Iworks GBAS

Our experience base and knowledge also includes a number of in-house legacy applications deployed at some of the largest Healthcare related organizations in the U.S.