Payer Claims & Administration Platforms Software Product Ranking Comparison

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administration platforms are essential for payer organizations, many of the products in the market are perceived as outdated, complex, and low performing (the market has one of the lowest average performance scores of any KLAS measures).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’.

Recent Insights

Key Findings:

HealthEdge Leads the Market in New Wins
Technology’s Robust Flexibility Creates New Efficiencies—and Some Complications
HealthEdge Has Improved Engagement & Delivery; Frustration Persists in a Few Areas
HealthEdge Viewed as Best Technology Option; Ability to Consistently Deliver Not Yet Proven
System Information Provided by HealthEdge

Performance Data

Overall Score by Product

Overall Score by Question Topic

Provider Facility Size by Product

Provider Facility Type by Product

Including payers and payer vendors in our research at KLAS has helped paint a broader picture of healthcare IT and measure healthcare more holistically.

Payer Core Administration solutions were born for another time, and health plans and vendors are realizing that these solutions need to be updated, revamped, or replaced for modern value-based care. K

Decision Insights

Payer Core Administration Platforms 2020

20 May 20 | Joe VanDeGraaff and Sam Eaquinto

A core administration platform is the transactional heart of a payer organization—it is used to enroll new members, process and pay claims, and manage product lines and benefits. Many of the products in this market, while needed and typically stable, have been around for decades and are highly customized, hosted on-premises, and often seen as old and complex. Many payers are therefore reluctant to replace these systems because the risks and required effort are so high. But recent buying activity suggests the payer core administration platform market is seeing revitalization. Triggered by the opportunities and challenges of payment reform and value-based care, payers are looking ahead and starting to bid for new vendor partners. KLAS spoke with 30 payer organizations who are making or have recently made purchase decisions, and they shared their candid feedback and insights regarding what vendors they have considered, selected, and/or replaced. These interviews reveal new energy and life in a market long overdue for change—in terms of both product and service delivery.

Payer Claims & Administration Platforms

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