Alternatives to SKYGEN Provider Data Management

Incredable is an all-in-one configurable credentialing solution that bridges the gap between healthcare facilities, providers, and administrators. The platform streamlines the entire credentialing process, from document management and compliance tracking to credential verification. Incredable ensures that healthcare professionals remain fully compliant and prepared at all times. Trusted across the healthcare industry, Incredable reduces administrative burdens, enhances operational efficiency, and fosters seamless collaboration among all stakeholders, allowing healthcare teams to focus on delivering quality care.

CredentialStream® incorporates patented technology that provides everything necessary for requesting, gathering, and validating information about a provider, all to establish a reliable Source of Truth for downstream processes. With a modern platform that is continuously updated, along with best-practice content libraries and industry-leading data sets, CredentialStream stands out as the most comprehensive provider lifecycle management solution available.

symplr Directory is an advanced solution for healthcare organizations to centralize, manage, and maintain accurate provider data across all departments. By offering a single, trusted data profile for every provider, symplr Directory helps reduce errors caused by data silos and improves operational efficiency. The platform enhances customer experience by enabling patients to find the right providers quickly and seamlessly book appointments. Integrated with EHRs, symplr Directory also streamlines workflows for healthcare providers and administrative teams, reducing administrative burden and accelerating reimbursement processes. Additionally, the platform provides actionable insights through robust reporting, clinical taxonomy for better patient-provider matching, and a national provider network that allows real-time enrollment of referring providers. This results in better network retention, reduced patient leakage, and improved patient acquisition and care delivery.

H1 Universe is an innovative platform that leverages artificial intelligence to enhance the management of healthcare data, offering users access to the most extensive global database of healthcare providers (HCPs). By merging information from various sources, such as public, private, and proprietary databases, H1 Universe provides valuable insights that are crucial for clinical trials, medical affairs, and commercialization efforts. This powerful tool enables healthcare teams to pinpoint essential stakeholders, refine clinical research processes, and make informed decisions swiftly, ultimately boosting overall efficiency within the healthcare landscape. Furthermore, the platform not only aids in real-time decision-making but also fosters collaboration among healthcare professionals, paving the way for improved patient outcomes.

Health systems can match patients to the right providers, optimize patient access, and manage data with industry-leading solutions. Our provider search and schedule solutions, built on the Kyruus data management platform, enable health systems to optimize matching between patients and providers; boost patient acquisition and convert; and deliver a consistently positive patient experience at key points of entry. Create a digital presence that is unique with a modern access experience for patients. This allows them to easily find the best care options and book online. By equipping your agents with the necessary technology, you can connect consumers with the best providers via your call center. Providers and staff will be able to see the providers in your network, and patients can leave their appointment knowing that the next one is already booked.

Reduce expenses, break down data silos, and enhance outcomes for your members with a cohesive, automated provider data solution. symplr Payer serves as a reliable single source of truth for provider data, ensuring it is regularly reconciled and verified against primary sources. This solution significantly boosts data quality, accessibility, and transparency. Additionally, it alleviates provider frustrations by eliminating redundant requests for information. By utilizing symplr Payer as the central hub for provider data across the enterprise, payers can disseminate timely and precise information to various downstream systems. Our comprehensive and adaptable provider data management solution oversees all pre-contract and renewal contract negotiations. You can streamline and standardize your contracting workflows while meticulously capturing contract specifics such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule information, and more. Furthermore, symplr Payer's innovative design enables your organization to effectively merge contracting and credentialing processes into one seamless operation. This integration not only simplifies management but also enhances overall efficiency in handling provider data.

Speed up payment processes while minimizing administrative tasks. With over 8,000 payer connections and established collaborations with more than 650 practice management vendors, our claims management solutions lead to a reduction in pending claims and decreased need for manual efforts. Efficiently and accurately send claims for various services, including professional, institutional, dental, and workers' compensation, ensuring prompt reimbursement. Tackle the evolving landscape of healthcare consumerism by delivering a smooth and transparent financial experience. Our patient engagement tools enable you to facilitate informed discussions around eligibility and financial obligations, while also lowering obstacles that could affect patient outcomes, ultimately fostering better healthcare experiences.

Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more.

For thirty years, Verisys has been a trusted partner to some of the most intricate healthcare entities in the United States, managing the credentialing of over two million events each year. Our provider credentialing solutions ensure that you maintain compliance effectively. The credentialing and re-credentialing of healthcare providers is a challenging task for hospitals, health plans, and health systems alike. With physicians holding licenses in multiple states and offering telehealth services across state lines, it becomes necessary to verify licenses with each respective state board and adhere to the distinct regulations set forth by those states. Additionally, identity verification can be intricate, as many physicians share similar names, including maiden names, aliases, nicknames, or shortened versions of their names. To obtain a comprehensive understanding, it is essential to screen each physician thoroughly and validate credentials against a myriad of primary sources. Our expertise spans from conducting straightforward provider credential searches to deploying comprehensive end-to-end credentialing systems that streamline the entire process. By relying on us, you can simplify the complexities of credentialing and focus on providing quality care.

symplr's provider credentialing software serves as a comprehensive solution for managing provider data, effectively reducing turnaround times and streamlining revenue cycles, all while ensuring that patient safety remains a top priority. This software simplifies the processes of data collection, secure access, reporting, and maintaining ongoing compliance, making it easier for providers, credentialing teams, and internal approval committees to manage their responsibilities. Users have experienced a significant 20% decrease in the time it takes to complete credentialing, with a remarkable 50% drop in the frequency of committee review meetings. By utilizing this automated and intuitive platform, organizations can efficiently collect, verify, store, and share vital provider lifecycle information and documentation in one centralized location, leading to both time savings and cost reductions. Additionally, the software includes a payer enrollment module that facilitates the enrollment of providers with payers, allowing for easy tracking of applications throughout the reimbursement process. With advanced automation capabilities, it gathers data from numerous primary sources and conducts automatic checks for expired or suspended licenses, as well as verifying against databases such as NPDB, DEA, and SAM, thus enhancing the overall efficiency and reliability of the credentialing process. Ultimately, symplr’s software transforms the way healthcare organizations handle provider credentialing, making it a crucial tool in the industry.

Certify offers an API-driven approach to credentialing, licensing, and enrollment tailored for payors, health systems, and fast-growing digital health enterprises. We provide essential insights that enhance the performance of clinicians, teams, and healthcare organizations alike. With our user-friendly one-click credentialing solution, you can create top-tier provider networks effortlessly. Our real-time, automated credentialing adheres to NCQA standards, making it easier to expand provider networks. We ensure continuous compliance through automated ongoing monitoring of your provider networks. By eliminating the uncertainties and administrative burdens of licensing, we enable you to expand into new markets without hassle. Join our network and expedite your reimbursement processes, allowing you to focus more on delivering care. Our streamlined approach facilitates cross-state licensure across all 50 states for any category of license, while also simplifying the payor enrollment process for providers entering new markets. Monitor your enrollment progress conveniently with our tailored dashboards, and utilize our superior methodology to refine, standardize, and enhance your provider data effectively. This comprehensive service not only supports compliance but also fosters growth in a competitive landscape.

Our platform fosters consistency, continuity, and scalability throughout our interconnected portfolio, allowing customers to enhance their operational efficiency, make informed decisions, and achieve better patient outcomes while driving innovation in our evolving healthcare system. By leveraging advanced data and analytics alongside patient engagement and collaboration tools, the Change Healthcare platform empowers both providers and payers to streamline workflows, obtain the necessary information precisely when needed, and ensure the delivery of the safest and most appropriate clinical care possible. We facilitate seamless access to data and promote interoperability among various data sources, thereby supporting CMS patient access and interoperability regulations, which ultimately leads to real-time access to clinical documents. This approach is instrumental in managing risk adjustment effectively, boosting HEDIS scores, and ensuring timely and precise payments through quicker adjudication. Furthermore, our commitment to innovation positions us to adapt to the changing landscape of healthcare while continually improving the services we offer.

Reclaim precious hours in your day and save millions with our innovative automated solutions. Connect effortlessly with essential stakeholders—providers, payers, and partners—while gaining access to real-time, precise data that ensures seamless care delivery. We simplify the intricate web of thousands of payer connections, allowing you to initiate quick and straightforward enrollments with ease. Experience the unparalleled capabilities of the cloud like never before. Our centralized command system enables you to manage, store, and share provider information in real-time, ensuring connectivity wherever necessary. Verification of providers is now a hassle-free process; simply make a request, and our platform will expedite it for you, enhancing your operational efficiency. Let us help you streamline your workflow like never before.

CORE unites various sectors of the industry to speed up automation and enhance business processes that simplify healthcare for patients, providers, and health plans alike. By leveraging the most reliable source of provider and member information, CAQH empowers healthcare organizations to cut expenses, enhance payment accuracy, and revolutionize their business operations. In the rapidly changing healthcare environment, ongoing advancements in payment and claims processing are crucial. Healthcare providers and health plans nationwide rely on CAQH to gather and oversee professional data, verify primary sources, and keep track of sanctions. Consequently, this leads to more efficient administration, improved regulatory compliance, and superior management of provider information. Ultimately, the collaboration fosters innovation and ensures that all stakeholders benefit from a more effective healthcare system.

Innovit's suite of iICE Training programs is specifically crafted to equip your workforce with essential knowledge and skills. By integrating industry best practices in managing product information, you can trust that your team will enhance systems and processes for sustainable master data management. As a worldwide solution provider, Innovit focuses on areas such as Master Data Management (MDM), Product Information Management (PIM), Global Data Synchronization (GDSN), Unique Device Identification (UDI) Compliance, and New Product Introduction (NPI) Workflow Automation software. These programs not only boost individual competencies but also foster a culture of continuous improvement within your organization.

Effective collaboration in patient care hinges on continuous connectivity and access to the latest information. It has become increasingly crucial to streamline the exchange of this information with insurers. Availity simplifies the process of working with payers, guiding you from the initial verification of a patient's eligibility to the final resolution of reimbursements. Clinicians desire quick and straightforward access to health plan details. With Availity Essentials, a complimentary solution backed by health plans, providers can benefit from real-time data exchanges with numerous payers they frequently engage with. Additionally, Availity offers a premium option known as Availity Essentials Pro, which aims to improve revenue cycle performance, minimize claim denials, and secure patient payments more effectively. By relying on Availity as your trusted source for payer information, you can dedicate your attention to delivering quality patient care. Their electronic data interchange (EDI) clearinghouse and API solutions enable providers to seamlessly integrate HIPAA transactions along with other essential functionalities into their practice management systems, ultimately enhancing operational efficiency. This comprehensive approach ensures that healthcare providers can maintain focus on their primary mission: patient well-being.

Model N offers a comprehensive platform that enables organizations to enhance their revenue while modernizing Sales, Marketing, Channels, Finance, and Legal workflows. By utilizing Model N’s revenue management tools, businesses can transform isolated, tactical operations into cohesive end-to-end revenue processes through the power of automation and intelligent insights. Revenue Cloud effectively connects front-office and back-office functions, creating a consolidated system of record for all revenue-related activities. This platform empowers clients to effortlessly configure and quote intricate products, swiftly finalize complex contracts, and gain access to accurate, real-time channel data, enhancing transparency within their channels. Furthermore, it streamlines the management of incentive programs, helping to prevent overpayments. Additionally, Model N’s Rebate Management feature enhances channel engagement, leading to improved revenue optimization. Ultimately, this holistic approach allows companies to achieve greater efficiency and effectiveness in their revenue generation efforts.

The health care sector faces significant challenges due to the complexities of CMS and state regulations, which often lead to increased time and costs. Daily struggles with outdated practices and the constant fear of failing to comply with regulations impact the communications and compliance teams of health plans. It is essential to streamline and gain oversight of your organization's compliance initiatives along with the entire material development workflow. CodySoft® offers an innovative suite of web-based software solutions tailored specifically for the intricate landscape of health plans. This platform enables more efficient and cost-effective management of marketing materials aimed at both members and providers. It helps minimize compliance risks while enhancing accuracy and simplifies the handling of investigation issues. Users can access their dashboards through a secure online portal without the need for IT integration. The software also allows for the straightforward generation of reports needed for regulatory audits and performance metrics, with updates visible in real-time, enhancing overall operational transparency. In a world where effective communication is vital, such tools can make a significant difference in ensuring organizational success.

HealthEC offers a premier population health management platform, featuring the CareConnect™ care management module and the 3D Analytics™ module, aimed at improving the quality of care and enhancing patient experiences by tackling the most significant data challenges in healthcare. By utilizing a universal data warehouse, it effectively integrates normalized claims, clinical, and social determinants of health (SDoH) data from various sources, ensuring CMS certification for reuse. The platform minimizes workflow interruptions through customizable care plans and decision-support tools, providing comprehensive care management assistance. It fosters patient-centered care by promoting seamless coordination with community resources while addressing SDoH. With clear dashboards and point-of-care access, it empowers healthcare professionals with actionable insights at the diagnosis, provider, practice, and organizational levels. Additionally, it enhances managed care organization (MCO) performance reviews and ensures compliance with CMS interoperability rules, thereby supporting healthcare providers in delivering superior outcomes. The integration of these features leads to a transformative approach to population health management.

Build the interoperability solution you need. Rhapsody is a flexible toolbox which allows your team to adapt to any modern environment. Rhapsody helps you provide the highest level service by ensuring healthcare data flows where, when and how your unique environment requires. Create flexible solutions for every connection requirement. Streamline workflows using a solution that's infinitely configurable, and specifically designed for healthcare. Create intricate integrations using a robust toolkit, which has been tested around the world. The platform has customers in 36 different countries. Create FHIR interfaces that are cutting edge with ease and simplicity using REST and FHIR specific JSON. Security is a primary concern, and is built into the entire product. This is to protect any protected health information that passes through the engine.

Post Acute Analytics (PAA) is at the forefront of revolutionizing care delivery to enhance patient well-being by utilizing real-time insights within an interconnected healthcare ecosystem. This advancement is facilitated through the deployment of our AI-driven, ready-to-use integration solution known as the PAA Anna™ Platform, which connects seamlessly with the systems of healthcare providers and payers. With Anna, there is complete visibility into patients' experiences during post-acute care, allowing for timely interventions that help avoid adverse quality and financial outcomes. By leveraging unique analytics and a comprehensive integration engine, along with expert medical guidance, our solutions empower healthcare providers and payers to make instantaneous, informed decisions that lead to improved patient outcomes and decreased overall care costs. This innovative approach not only enhances the efficiency of care but also fosters a more responsive healthcare environment.

MantraComply offers a robust platform for credentialing and enrollment of healthcare providers. Our extensive range of services includes provider credentialing, payer enrollment, license verification, hospital privileging, and management of healthcare compliance. With the trust of numerous providers, health plans, payers, group practices, and digital health firms, MantraComply facilitates quicker onboarding of providers, minimizes denials, and enhances adherence to regulations. We incorporate AI-driven insights and allow customization of credentialing workflows, coupled with round-the-clock expert assistance, enabling healthcare organizations to maintain compliance while prioritizing patient care. Additionally, MantraComply is supported by a notable $15 million investment from Impanix Capital, highlighting our commitment to innovation in the healthcare sector. Our mission is to streamline processes and improve efficiency for all stakeholders involved in healthcare delivery.

Leveraging AI as a foundational strategy for payers, providers, and pharmacy benefit managers involves developing cloud-based products and platforms that enhance operational efficiency. A "healthcare digital platform" represents the amalgamation of various applications and cutting-edge technologies to deliver customized healthcare solutions that positively influence business results, marking a progressive and expedited shift away from traditional core administration processing systems (CAPS). To gain insights into how digital platforms and emerging technologies can help meet business goals, as well as their effects on healthcare payer key performance indicators (KPIs) and the overall appeal of these platforms, Infosys collaborated with HFS to survey 100 C-suite healthcare payer executives across the United States. This initiative aims to shed light on the evolving landscape of digital healthcare solutions and their potential for transforming industry practices.

Milliman MedInsight® was founded in 1998 and is a leading provider for healthcare data and analytics. Over 300 payers/ACOs/employers and government agencies trust Milliman MedInsight. Our comprehensive suites of analytics and data enable organizations to leverage healthcare information for better clinical and financial outcomes. We deliver actionable insights on healthcare utilization, costs and quality using our deep industry expertise and advanced technologies. Milliman MedInsight empowers stakeholders with the tools they need to navigate the healthcare landscape, from risk management to value-based care.

HealthStream supports EchoOneApp, a legacy platform. CredentialStream is recommended for new customers.

Authorize, claim processing and payment are available at the point-of-care. Improve care coordination and improve outcomes for lower medical costs while streamlining administrative processes. Engage providers at point of care to share and capture data in real time, resulting in an unprecedented exchange of health information. We work with our clients to develop risk management strategies that produce better outcomes at lower costs. We aim to improve the user experience of everyone in the ecosystem. To optimize clients' resources, we deliver a minimum of a 3:1 ROI. Conexia has created a core technology platform (ONE), which can be customized to meet the different regulatory requirements and operational processes of each client in each geographic region. Our initial implementation is usually an overlay on the existing technology ecosystem of the payer to create real-time processes.

Our services for Provider Enrollment and Credentialing assist healthcare providers in securing and maintaining their enrollment, ensuring that payers have all necessary information to process claims efficiently. We focus on New Provider Enrollment by fostering relationships with new or previously unengaged payers to enhance revenue potential. Our re-credentialing process addresses the requirements of commercial payers and hospital applications, while our Annual Maintenance services include CAQH Maintenance and Attestation, as well as re-validations for both Medicaid programs and managing expiration dates for DEA, licenses, malpractice insurance, and more. Navigating the complexities of credentialing for your healthcare facility can be a daunting task that consumes significant staff resources. As a comprehensive revenue cycle management firm, we recognize the crucial role that provider credentialing plays in maintaining a healthy cash flow. Our credentialing services cater to both new and existing providers, ensuring that all necessary documentation and relationships are in place for seamless operations. By utilizing our expert services, healthcare practices can focus more on delivering quality care rather than getting bogged down by administrative burdens.

Transforming patient care into revenue can be streamlined with precise insights into every financial choice made. Affinity Revenue Cycle Management minimizes reliance on additional applications, resulting in reduced overall collection costs from both payers and patients. By integrating the finest healthcare software solutions into a single platform, organizations can enhance efficiency. Automation of the revenue cycle not only lowers collection costs but also accelerates the claims process. Harris Affinity provides healthcare entities the ability to concentrate on their core mission: delivering excellent patient care. Our RCM software not only automates revenue processes but also simplifies claim handling and reduces collection expenses. Utilize electronic transactions (EDI) to communicate directly with payers or clearinghouses effortlessly. Gain immediate access to screens without needing to reach out for support. Analyze essential data through intuitive dashboards and optimize complex scheduling workflows seamlessly. Additionally, send automated appointment reminders to enhance patient engagement and reduce no-show rates.

Our comprehensive platform provides fully integrated health plan solutions that add value and reduce the complexities of healthcare for employers, members, providers, and payers alike. Valenz combines member-focused services with insights derived from data, creating connections through personalized assistance that leads to high-quality care and enhanced outcomes. We prioritize early and frequent engagement through effective education, support, and services designed to prevent more severe and costly health issues down the line. By choosing Valenz, you can foster a healthier member population while consistently achieving cost savings for both plans and members year after year. To access the transparency and tools necessary for making quality-driven, cost-effective decisions, let’s discover your pathway to more efficient healthcare today. Additionally, the Valenz healthcare ecosystem optimization platform features a suite of fully customizable solutions that are all integrated within a single strategic framework, providing in-depth visualization of cost, quality, and utilization opportunities, ensuring you are equipped to navigate the healthcare landscape effectively.

Valer’s innovative technology streamlines and accelerates the processes of prior authorization and referral management by facilitating automated submissions, status checks, verifications, reporting, and EHR synchronization, all from a single platform that caters to mid-to-large-sized healthcare facilities, various specialties, and multiple payers. Designed to meet the specific needs of users, Valer stands out as a comprehensive solution that accommodates all specialties and payers, in contrast to generic products that often restrict specialties and service lines and lack automation for submissions. The platform's user-friendly interface boosts staff productivity, simplifies the training process, and monitors both staff and payer performance across diverse service lines, fostering an environment of ongoing enhancement. Valer goes beyond merely connecting with a handful of payers; it integrates seamlessly with all payers, ensuring compatibility across all specialties, service lines, and care environments, and provides real-time updates on payer rules to keep your operations current. With Valer, healthcare organizations can experience a revolutionary shift in how they manage prior authorizations and referrals, paving the way for improved efficiency and patient care outcomes.

Preventive medicine represents the next frontier in healthcare. Our mission is to assist healthcare providers in identifying and addressing high-risk patients effectively, thereby ensuring patient safety. This proactive approach aims to reduce the incidence of Adverse Drug Reactions (ADRs) within healthcare facilities, where studies show that 5%-10% of hospitalized patients experience ADRs, leading to increased risks, prolonged hospital stays, and financial losses due to denied reimbursements for extra days and procedures. Notably, these adverse events are avoidable. We collaborate with Accountable Care Organizations (ACOs), Health Maintenance Organizations (HMOs), and payers to minimize unnecessary emergency room visits and hospitalizations, particularly focusing on the elderly population, as data indicate that 15%-30% of ER visits for patients aged 65 and older are attributed to ADRs, frequently resulting in hospital admissions. These preventable occurrences highlight the importance of our work. Our approach is founded on advanced scientific principles that integrate multidisciplinary research. Our technology leverages cutting-edge medical research alongside innovative data science, creating a robust platform that leads to improved patient outcomes and enhances overall healthcare efficiency.

SE Healthcare's Physician Empowerment™ Suite offers a range of specialized data analytics tools designed to help your practice thrive in a highly competitive environment. Ensure you receive the reimbursement you rightfully deserve from insurance providers while simultaneously making your practice more appealing to networks. By improving your reputation and transparency, you can effectively turn website visitors into new patients. Additionally, retain your existing patients by identifying challenges and enhancing their experience. Foster a positive workplace culture for physicians, boost patient engagement, and elevate satisfaction levels. Tackle pressing issues such as physician burnout, quality of care, and safety concerns. The suite provides valuable insights into overlooked problem areas, ultimately leading to improvements in patient experience, engagement, and overall practice performance, ensuring your practice remains at the forefront of healthcare excellence.

For many years, we have been the trusted partner for our healthcare clients, addressing their essential business challenges. HGS Healthcare Technology adopts a comprehensive consulting strategy to uncover the fundamental issues affecting healthcare payers and providers, thoroughly assess these problems, and deliver an all-encompassing solution that focuses on enhancements in personnel, processes, and technological platforms. With a strategic solutions-oriented approach, our primary goal is to prioritize what provides the greatest advantage to our clients. By utilizing a tailored solution roadmap, our team of operations and technology specialists will recommend precise modifications aimed at boosting efficiency, engagement, data management, and overall workflow processes. We employ proven strategies designed to create better experiences for members. Furthermore, HGS seamlessly integrates with or adapts your existing systems, ensuring that solutions are customized to meet your specific requirements. Ultimately, our commitment is to foster long-term relationships by continuously evolving our services to match your needs.

Experience a streamlined workflow with real-time transactions integrated into current technology platforms. This approach enables providers and payers to cut down on time and effort by as much as 90% when it comes to benefits and utilization management. By eliminating the opaque nature of the existing benefits and utilization management system, confusion is significantly reduced for patients, providers, and payers alike. With self-learning automation and fewer clicks required, more time can be dedicated to patient care, allowing providers and payers to concentrate on what truly matters. Myndshft addresses the complexities of multiple point solutions by offering a cohesive, end-to-end platform that facilitates immediate interactions among payers, providers, and patients. The platform not only dynamically updates its automated workflows and rules engines based on real-time feedback from provider-payer interactions but also continually adapts to the specific rules utilized by payers. As usage increases, the system becomes increasingly intelligent, drawing from a comprehensive library of thousands of regularly updated rules tailored for national, state, and regional payers, thereby enhancing efficiency and effectiveness in the healthcare landscape. Ultimately, as the technology evolves, it fosters an environment where care delivery can be optimized, benefiting all stakeholders involved.

Enhance clinical quality metrics, improve the accuracy of risk scores, boost patient and provider involvement, elevate patient outcomes, ensure operational transparency, and optimize economic performance through a singular, integrated suite of software solutions. The Inovalon Payer Cloud revolutionizes conventional workflows by transitioning them into data-driven methodologies that align with your health plan’s primary goals. Supported by top-tier analytics capabilities, our unified SaaS solutions provide the essential member-centric insights along with the speed, precision, and adaptability required to maintain a competitive edge in today’s varied and rapidly evolving market. Inovalon's healthcare payer SaaS suite not only delivers valuable insights and actionable strategies but also empowers health plans to assess, manage, and enhance health outcomes, economic efficiency, and the overall quality of care. With our payer solutions, stakeholders can achieve improved member care and outcomes while simultaneously enhancing operational performance and efficiency, leveraging advanced analytics and agile business intelligence tools to navigate the complexities of the healthcare landscape more effectively. As a result, organizations can cultivate a proactive approach to healthcare management, ensuring they are well-equipped to meet both current and future challenges.

CredentialMyDoc is a web-based software that makes it easy to enroll providers and create credentialing documents. It streamlines data entry and validation, reduces errors on forms, streamlines billing and increases provider satisfaction.

Enable patients to navigate their own healthcare needs and connect with the most suitable services. Our approach assists healthcare providers and systems in attracting new patients while ensuring the satisfaction and retention of current ones through a more consumer-focused experience. This ultimately leads to improved patient involvement and health results, all while streamlining workflows and boosting overall efficiency. Additionally, we support health plans and payers by providing their members with tools for self-service symptom assessment, triage, and clear guidance to identify the most appropriate, convenient, and cost-effective in-network care options. We collaborate with companies in digital health, healthcare innovation, and healthcare SaaS to enrich their digital health offerings with clinically-validated AI chat solutions, ensuring that patients receive timely and accurate assistance in managing their health. By leveraging technology and partnerships, we aim to transform the way healthcare is accessed and delivered.

MAPay is a revolutionary decentralized payment network solution designed to enhance security, reduce transaction costs, and elevate payment efficiency for a wide range of industry participants. This innovative platform, created by a global healthcare technology company, operates independently of specific platforms, thereby transforming the healthcare payment landscape. Positioned to become a frontrunner in healthcare payment processing, MAPay addresses the prevalent challenges in the current healthcare system, which often operates as a zero-sum game characterized by misaligned incentives, opaque billing practices, and incompatible systems that inflate care costs while compromising quality. Every day, the Network tackles new use cases across healthcare systems, governmental bodies, medical applications, and corporate healthcare, inviting stakeholders to present their challenges for resolution. At its core, the network employs a sophisticated hybrid architecture that combines distributed ledger technology with traditional databases and payment processing systems, ensuring robust functionality and reliability. This unique approach not only streamlines transactions but also fosters greater collaboration and trust among all parties involved in the healthcare ecosystem.

EMCsoft's Claims Management Ecosystem guarantees that healthcare providers and billing companies submit accurate claims to insurance payers for effective claim processing. This system combines our adaptable claims processing software, Claim Agent, with a comprehensive methodology known as the Four Step Methodology, seamlessly integrating into your claim adjudication workflow. By implementing this strategy, we enhance, facilitate, and automate your processes to optimize claim reimbursements. For an insightful overview of Claim Agent's features and its integration into your claims process, you can request our complimentary online demonstration. Claim Agent efficiently manages the scrubbing and processing of claims, ensuring a smooth transition from provider systems to insurance payers in a timely and cost-effective manner. The software is designed to be compatible with any existing system, ensuring a swift and straightforward implementation. Furthermore, we offer tailored edits, bridge routines, payer lists, and workflow configurations that cater specifically to each user's requirements, enhancing the overall claims management experience. This personalized approach enables healthcare providers to focus more on patient care while we take care of the complexities of claims processing.

As a company that emphasizes value-driven healthcare, effective communication through a versatile and scalable platform is essential for your success. NaviNet Open stands out as one of the premier collaboration platforms in the United States, enhancing engagement among providers and producing reliable, actionable insights throughout the healthcare delivery process. This secure multi-payer system not only improves communication but also boosts operational efficiency, reduces expenses, and heightens provider satisfaction. It enables real-time exchanges of crucial administrative, financial, and clinical data between payers and providers. For NantHealth, prioritizing security is paramount. Our adherence to HIPAA regulations, coupled with a steadfast commitment to our core values, has earned us EHNAC HNAP accreditation since 2006. Additionally, NaviNet Open holds HITRUST certification, demonstrating compliance with critical regulations and industry standards. This platform effectively mitigates risks associated with third-party privacy, security, and compliance, ensuring a robust framework for all users. Such dedication to security and efficiency fosters an environment of trust and collaboration in the healthcare ecosystem.

We are revolutionizing the healthcare landscape by implementing cutting-edge technology designed to alleviate the challenges faced by payers and providers, leading to streamlined administration, enhanced transparency, and a more efficient overall system. Improve your interactions with providers through cost-effective self-service options and detailed reporting capabilities. Transition from outdated and expensive on-premise systems to a unified cloud-based SaaS platform that emphasizes user-friendliness and clarity. Optimize your workflows, reduce redundancies, and foster collaboration across teams using the tools available on the platform. Effortlessly explore and understand the relationships among policies, claims, providers, and customizations within your integrated system. Keep track of your performance and uncover new avenues for savings with our dynamic aggregate dashboards and detailed policy insights. This approach not only enhances operational efficiency but also empowers stakeholders to make informed decisions that positively impact patient care.

ReferralMD is the most trusted referral management, provider management and patient engagement platform. Referral management, e-consults and provider CRM are key tools to reduce leakage and increase market share. ReferralMD offers proven referral management, econsult, and telehealth solutions. These solutions help hospitals, health networks, and payers to streamline the referral process, reduce patient leakage, and improve communication between patients and providers. ReferralMD provides powerful clinical decision support tools, real-time analytics and customer service improvement to healthcare providers.

CareStat represents SHP's all-encompassing analytics solution for post-acute care, effectively connecting acute care providers, ACOs, payers, and physician groups with skilled nursing facilities and home health agencies. Our mission is to collaboratively enhance the management of patient outcomes, operational efficiency, utilization, and partnerships between post-acute providers. Utilizing SHP's exclusive readmission algorithms, CareStat integrates real-time OASIS and MDS data to facilitate patient management throughout the entire care continuum. This implementation not only aims to minimize readmissions and shorten hospital stays but also to foster better collaboration and improve referral practices, ultimately leading to heightened patient satisfaction. By streamlining the data transfer process for quality and outcome metrics, we help organizations save valuable time. In a metrics-driven landscape, your organization understands the necessity of actionable insights, and achieving your goals demands the right tools and expertise to function optimally. Overall, CareStat is designed to empower providers with the insights they need to drive better patient care outcomes.

Jenzabar One serves as a versatile and cloud-compatible platform tailored exclusively for the higher education sector. Our robust array of technology products and services equips your campus with mobile-responsive solutions aimed at enhancing both institutional and student achievements. Achieve and exceed your advancement objectives by effectively planning, developing, nurturing, and managing relationships with stakeholders, all through a unified system. Jenzabar Fundraising aids educational institutions in pinpointing potential donors and fostering engagement through contemporary, personalized communication methods focused on optimal solicitation strategies. Jenzabar SONIS stands out as an efficient and budget-friendly student information system that boosts productivity for all your mobile constituents. Specifically crafted for smaller or niche schools, Jenzabar SONIS enables you to oversee every facet of your institution’s administrative operations online, while offering integrated services for admissions, registration, grading, billing, course management, and various other administrative tasks, ensuring an all-encompassing solution for educational management. Ultimately, leveraging these tools allows institutions to not only streamline their operations but also enrich the overall educational experience for their students.

blueBriX delivers unique digital health solutions designed to empower healthcare systems to excel in value-based care, prioritizing accessibility, cost-effectiveness, equity, and quality.