Payer Software
Subject Expert
Mark Allphin
Senior Vice President of Engagement
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Associated Market Segments
Care Management Solutions (Payer)
Standalone vendor solutions that provide analytics and workflow capabilities to help healthcare payers manage and improve...
Claims & Administration Platforms (Payer)
Core claims/administration systems used by health plans to process and pay (adjudicate) claims, enroll health plan members,...
CMS Payer Interoperability
Software designed to meet requirements for CMS-regulated payers and state agencies by providing a patient access API,...
Customer Relationship Management (CRM)
Systems that manage patients' contact data by organizing and managing current patients and potential/acquired patients, much...
Data Intelligence & AI Platforms (Payer)
Payer software solutions that unify clinical, member, operational, financial, and other healthcare data to support enterprise...
Payer/Provider Data Exchange
This segment includes solutions used by payers and providers to support cross-organizational workflows that rely on sharing...
Post-Payment Accuracy & Integrity Solutions (Payer)
Vendor software solutions used by health plans to help ensure accurate payment/reimbursement to providers. Specifically...
Pre-Payment Accuracy & Integrity Solutions (Payer)
Vendor software solutions used by payers to help ensure accurate payment/reimbursement. Common capabilities in payment...
Quality Measurement & Reporting (Payer)
Vendor solutions used by health plans to measure and report performance on quality of care. Common solution capabilities...
Risk Adjustment: Coding, Retrieval & Compliance Solutions
Technology and services that support accurate, efficient, and compliant risk adjustment coding, chart retrieval, RADV...
Risk Adjustment: POC & In-Home Health Assessments
Healthcare services and technology designed to support risk adjustment initiatives by enabling health systems to perform...
