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Payer/Provider Data Exchange

This segment includes solutions used by payers and providers to support cross-organizational workflows that rely on sharing clinical information. KLAS evaluates these solutions based on customer-reported experiences and outcomes related to how well the solutions support multiple payer/provider workflows, including chart retrieval, quality reporting, care gap closure, care management and event notifications, and data sharing to support value-based and shared-risk care models. Solutions in this segment may support these workflows through embedded (EHR-native) or non-embedded (third-party) models.

Subject Expert
Jaren Day
Research Director
KLAS Research Director - Jaren Day
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Latest Related Report

Points of Light 2023 Case Study 4: Combining Payer and Provider Intelligence by Incorporating Claims Data at the Point of Care) Report Cover Image
Point of Light
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Points of Light 2023 Case Study 4: Combining Payer and Provider Intelligence by Incorporating Claims Data at the Point of Care
13 April 23
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.

Report Abstract

Key Findings:

  1. Executive Summary
  2. The Collaborators
  3. Points of Friction—Challenges to Be Solved
  4. Action Plan—How the Collaborators Worked Together to Reduce Friction
  5. Points of Light—Outcomes Achieved through Collaboration
  6. Lessons Learned—What Best Practices Can Other Organizations Replicate?
  7. What's Next?—Vision for the Future
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Performance Data

Overall Score by Product

Example Payer/Provider Data Exchange overall score by product image

Overall Score by Question Topic

Example Payer/Provider Data Exchange overall score by question topic image

Provider Facility Size by Product

Example Payer/Provider Data Exchange provider facility size by product image

Provider Facility Type by Product

Example Payer/Provider Data Exchange provider facility type by product image
Current Time Inside Cache Tag Helper: 2/8/2026 8:12:49 AM and Model.SegmentId = 508
Related ReportsView All Reports
Point of Light
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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.
Point of Light
KLAS article icon
Points of Light 2023 Case Study 1
12 April 23    |   Aurene Wilford and Boyd Stewart
Seeking to ease the administrative burden created for both sides by manual denial and prior authorization processes, the collaborators in this case study first identified common pain points and then established shared goals. One of their initial projects was to reduce the need for Payer Organization 1’s clinicians to request additional information from Healthcare Organization 1 during claims review. To accomplish this, they utilized the Clinical Document Exchange within Epic Payer Platform to give the clinicians in-workflow access to members’ clinical data. The results have been improved efficiency, a significant reduction in denials, and a more trusting relationship.



Reducing Filters

Unlike sizing filters, reducing filters DO NOT recalculate scores based on the evaluations that meet these requirements. They narrow the list of solutions to show the vendors and solutions that can meet a specific need.

This data is based on interviews with a sample of the firms' recent clients. As a result, it is not necessarily comprehensive of all work a firm may do in this segment.

We require a minimum of 2 confirmations of a service performed in the last 3 years for a solution to qualify.

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