Payer Software
Subject Expert
Mark Allphin
VP of Engagement
Preferences
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 Analytics Platforms (Payer)
Payer software solutions that provide enterprise analytics and reporting on clinical, member, operational, and financial...
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...
