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6 Must-Haves for Modern Payer Solutions Software

payer solutions software | healthedge

In today’s rapidly evolving healthcare landscape, health plans face increasing challenges to provide quality care while identifying new efficiencies. As a result, more health plans are turning to technology and modern payer solutions software to help automate manual tasks, improve payment accuracy, and empower team members with more real-time data.

Six things health plan leaders should expect from their modern payer solutions software

Streamline administrative operations

Payer solutions software should automate labor-intensive processes such as claims processing, enrollment management, and provider network management. Health plans should be able to consolidate and manage data from various sources, which enables payers to reallocate resources to more critical areas, ultimately leading to increased operational efficiency.

Improve payment accuracy

Payer solutions software must be able to help health plans increase efficiencies within their claims payment operations to not only streamline processes, but also increase payment accuracy. This, in turn, helps reduce the downstream work staff members have to perform to reconcile inaccurate payments.

Enhance member engagement

By using modern payer solutions software, health plans can more efficiently identify at-risk member populations and deploy more targeted member outreach, health plans are able to not only streamline care management workflows, but also increase the productivity and scale of care management teams. Plus, with more personalized engagement, members are more likely to adhere to their care plans and improve outcomes.

Optimize claims and configuration management

Payer solutions software should support automated claims processing and contract configuration. As the industry evolves at a rapid pace, the system should enable business agility and speed to market. Additionally, the solution should provide advanced analytics help health plans identify cost-saving opportunities, such as identifying and preventing fraudulent claims, negotiating more favorable contracts with providers, and optimizing risk adjustment models.

Facilitate value-based care

As the healthcare industry shifts towards value-based care models (paying for value and outcomes vs. paying for volume), modern payer solutions software must be able to accommodate for multiple, complex payment models. Strong data analytics and reporting capabilities are also important capabilities that help health plans assess provider performance, identify high-risk members, and implement targeted interventions, which in turn enables health plans to drive better health outcomes and cost savings.

Promote interoperability and integration

Modern payer solutions software must be able to support interoperability and integration with third-party systems to not only comply with emerging regulatory requirements, but also to meet rapidly evolving market dynamics. A robust set of APIs should be available to support the exchange and use of third-party data, and in some cases, pre-packaged integrations should be available to help minimize the IT burden and accelerate time to market.

Health plans achieve extreme efficiencies with HealthEdge payer solutions software

In the face of an ever-changing healthcare landscape, health plans need modern payer solutions software like HealthEdge’s comprehensive suite of software solutions that can enable business agility and create extreme efficiencies.

HealthEdge’s comprehensive suite of payer solutions software applications meet the above-mentioned requirements for modern payer solutions software, and more.