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2018 Best In KLAS Payer Claims & Administration Platforms

2018 Best in KLAS Payer Claims & Administration Platforms

2023 BEST IN KLAS

Who is Best in KLAS?



How do they score? In five key performance categories

Market Segment Average   Conduent


Sales & Contracting

Implementation & Training

Functionality & Upgrades

Service & Support

General

50
100

Solutions Not Ranked

Limited Data Products

Score

Aldera Healthcare Payer and Administrator System*

81.9

Component [C], Not Primary [NP], Regional [R] or Limited Market Share [MS]

GE Healthcare Centricity Financial Risk Manager (Payvider market only)* [C]*

77.2

Tapestry (Payvider market only) [C]*

83.4

*Does not meet minimum KLAS Konfidence level.

Trend does not include the Best KLAS score

See the latest BEST IN KLAS 2018

2023 Best in KLAS Awards - Global Software
2023 GLOBAL
2023 Best in KLAS Awards - Software and Services
2023 BEST IN KLAS

How do Payer Claims & Administration Platforms solutions compare?


How do the top three solutions trend?


Conduent-Health Solutions Plus (HSP) MediTrac
Cognizant-Cognizant Trizetto Core Claims/Administration Solutions
Cedar Gate Technologies-Citra Health Solutions EZ-CAP

Past Payer Claims & Administration Platforms Awards

2023
Claims & Administration Platforms (Payer) 2023 Claims & Administration Platforms (Payer)
2022
Payer Claims & Administration Platforms 2022 Payer Claims & Administration Platforms
2021
Payer Claims & Administration Platforms 2021 Payer Claims & Administration Platforms
2020
Payer Claims & Administration Platforms 2020 Payer Claims & Administration Platforms
2019
Payer Claims & Administration Platforms 2019 Payer Claims & Administration Platforms
2018
Payer Claims & Administration Platforms 2018 Payer Claims & Administration Platforms
2017
Payer Claims and Administration Platforms 2017 Payer Claims and Administration Platforms
Related ReportsView All Reports
First Look
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SKYGEN Core Administration Solutions
02 August 23    |   Jacob Brown and Joe VanDeGraaff
SKYGEN aims to transform benefits management and administration for specialty payers to reduce costs and increase satisfaction for all involved. Currently focused on dental and vision payers, SKYGEN offers a variety of technology to fill all common core administration needs. All solutions are available as a SaaS platform or through SKYGEN’s third-party administrator (TPA) model. This report examines the SKYGEN customer experience.
Emerging Technology
KLAS article icon
Viveka Health Benefits Administration Platform
16 June 23    |   Jacob Brown and Joe VanDeGraaff
The complexity of benefits administration can draw focus away from improving health and wellness opportunities for health plan participants. Viveka Health’s benefits administration solution aims to help by integrating all functionality required to administer benefits into one comprehensive platform, allowing payers to communicate, manage claims, and analyze data all in one place. This report explores the experiences of six unique Viveka Health customers and their satisfaction with the platform.
Point of Light
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Points of Light 2023 Case Study 4
13 April 23    |   Aurene Wilford and Boyd Stewart
Claims data from payer organizations can give providers a more comprehensive view of a patient’s clinical history and thereby improve the quality of care they are able to deliver. Yet incorporating this information at the point of care can be expensive and challenging. To tackle this problem, the collaborators in this project worked to map the payer organization’s claims data so that it could be incorporated into provider workflows in real time at the point of care.
Point of Light
KLAS article icon
Points of Light 2023 Case Study 9
13 April 23    |   Aurene Wilford and Boyd Stewart
Submitting and following up on requests for prior authorization is often a manual, time-consuming process, creating administrative burden for both payer and provider organizations and potentially delaying needed care for patients. The stakeholders in this collaboration worked to streamline the process by automating the submission and follow-up for authorization requests, enabling providers to complete these tasks from within their EMR workflow. Results include faster turnaround times, reduced administrative workload, and fewer denials.
Performance
KLAS article icon
CMS Payer Interoperability 2022
13 September 22    |   Joe VanDeGraaff and Ruirui Sun
CMS recently issued a new regulation stipulating that CMS-regulated payers must be able to securely store and share patient data under the HL7 FHIR standard. To achieve this, organizations use CMS payer interoperability products, which usually provide capabilities such as patient access APIs, provider directory APIs, and payer-to-payer data exchange. Health plans and state agencies are evaluating how well technology vendors’ existing or newly developed solutions can help them stay compliant with the new CMS requirements. This report is KLAS’ first to validate the purchase decisions and customer experience of some of the vendors in this area.
White Paper
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Payer Claims & Administration Platforms
08 September 22    |   Joe VanDeGraaff and Ruirui Sun
Value-based care models have created widespread recognition among health plans that flexible technology is a must, while the need to be more member-centric and digitally focused is driving a desire for better integration between claims platforms and other payer HIT applications. This vendor guide is intended as a simple starting point for health plans and TPAs investigating payer claims and administration platforms. The guide is limited only to vendors with commercial software solutions (services firms are not covered) and includes all vendors known to KLAS as of July 2022.
Performance
KLAS article icon
HealthEdge Core Payer Administration Platform 2021
26 October 21    |   Jennifer Hickenlooper and Joe VanDeGraaff
Though core administration platforms are essential for payer organizations, many of the products in the market are perceived as outdated, complex, and low performing (the market has one of the lowest average performance scores of any KLAS measures). However, HealthEdge has recently seen increased attention from both small and large health plans, who view the vendor’s technology as innovative and who have been asking KLAS for vendor insights. This report examines the experience of HealthEdge customers and how the HealthEdge technology stands out from competitors’.
Best in KLAS
KLAS article icon
2021 Best in KLAS Awards - Software and Professional Services
02 February 21    |   Mark Allphin and Sam Eaquinto
The Best in KLAS report recognizes software and services companies who excel in helping healthcare professionals improve patient care. All rankings are a direct result of the feedback of thousands of providers over the last year. A Best in KLAS award signifies to the healthcare IT industry the commitment and partnership that the top vendors should provide. Read the report to see the top-rated medical software and services for 2021. Watch sessions from our first-ever virtual Best In KLAS Award Show to hear from the winning vendors in each segment. View Awards Show Recordings

Konfidence

Konfidence level
Konfidence Level Description
Products must have at least 30 live organizations participating for software and at least 15 live organizations for professional services. Exception to this is Transcription Services (30).
Products must have at least 20 live organizations participating for software and at least 10 live organizations for professional services. Exception to this is Transcription Services (20).
Products must have at least 15 live organizations participating for software and at least 6 live organizations for professional services. Exception to this is Transcription Services
-
The Konfidence level on this product rating is low. These results are for early trend detection. As more performance data is received, the result is likely to have a wide variance.
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