2021 Best In KLAS Payer Claims & Administration Platforms

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.

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.

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.

White Paper

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.

Company/solution	Overall performance score (100-point scale)	Total evaluations	Trend (2020-2021)	Culture	Loyalty	Operations	Product	Relationship	Value

Cognizant Trizetto Core Claims/Administration Solutions	78.0	n=32	0%	C+	B	B-	C+	C+	C-

Advantasure Core Administration Solutions	60.9	n=23	0%	F	D+	D-	D-	D	F
	50.0	100.0

Company/solution	Trend (2020-2021)	Culture	Loyalty	Operations	Product	Relationship	Value

Cognizant Trizetto Core Claims/Administration Solutions 78 n=32 COMMENTS	0%	C+	B	B-	C+	C+	C-
Advantasure Core Administration Solutions 60.9 n=23 COMMENTS	0%	F	D+	D-	D-	D	F

Company/solution	Overall performance score (100-point scale)	Total evaluations	Culture	Loyalty	Operations	Product	Relationship	Value

athenahealth athenaIDX Financial Risk Manager * [C] L C	82.5	n=7	B	C+	B	B	B	B

Conduent HSP (MediTrac) * L	82.2	n=12	B	A-	B-	B	C+	B-

Epic Tapestry [C] C	81.6	n=15	B-	B	B-	B-	B+	B-

HealthEdge HealthRules Payor * L	76.2	n=9	D-	A-	C	B-	C-	C+

SS&C Health DST Health Solutions Core Claims/Administration Solutions * L	54.4	n=10	D	F	D	F	D	F

Company/solution	Overall performance score (100-point scale)	Total evaluations

athenahealth athenaIDX Financial Risk Manager * [C] L C culture B loyalty C+ operations B product B relationship B value B	82.5	n=7

Conduent HSP (MediTrac) * L culture B loyalty A- operations B- product B relationship C+ value B-	82.2	n=12

Epic Tapestry [C] C culture B- loyalty B operations B- product B- relationship B+ value B-	81.6	n=15

HealthEdge HealthRules Payor * L culture D- loyalty A- operations C product B- relationship C- value C+	76.2	n=9

SS&C Health DST Health Solutions Core Claims/Administration Solutions * L culture D loyalty F operations D product F relationship D value F	54.4	n=10

Payer Claims & Administration Platforms

Past Payer Claims & Administration Platforms Awards

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