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Payer Core Claims and Administration 2017

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Payer Claims & Administration Platforms 2023 Payer Claims & Administration Platforms 2023
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Payer Claims & Administration Platforms 2023
Vendor Performance in a Segmented Market

author - Joe VanDeGraaff
Joe VanDeGraaff
author - Jennifer Hickenlooper
Jennifer Hickenlooper
author - Ruirui Sun
Ruirui Sun
August 15, 2023 | Read Time: 14  minutes

In recent years, the complex payer claims and administration market has seen several changes. Historically, payers have used multiple technology vendors and homegrown tools to meet their broad functionality needs. Now, payers are looking to consolidate platforms to improve efficiency and their ability to manage multiple business lines. As finding a platform that meets payers’ complex needs can be challenging, this report provides a comprehensive look at which business lines vendors are focused on, which vendors are gaining or losing market considerations, and how satisfied customers are with their platforms.

Note: In this market, vendors that serve only certain types of health plans are designated as component solutions and marked with a [C]. For a complete view of all vendors and their target clients, please see Vendors at a Glance.

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Key Findings:

  1. Cognizant & HealthEdge Are Clear Mindshare Leaders; Support & Delivery Challenges Remain for Customers of Both
  2. Provider-Sponsored Health Plans Frequently Consider Epic; SS&C Health* Continues to Lose Customers
  3. SKYGEN USA & Viveka Health Seen As Solid for Specialty Plans & Small Plans (Respectively); Mphasis (Eldorado)* Still Falling Short of Customer Expectations
author - Natalie Hopkins
Natalie Hopkins
author - Breanne Hunter
Breanne Hunter
author - Andrew Wright
Project Manager
Andrew Wright
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.