Innovative Healthcare Payer Solutions

We help healthcare organizations leverage advanced technologies to engage, communicate and connect with their patients and referring organizations. We have experience in developing CRMs that are customized to the needs of each organization and can integrate data from various information systems to provide a comprehensive view of patient data, while ensuring HIPAA compliance and data security. These CRMs enable organizations to enhance the overall patient experience and improve the quality of care.

Frauds in healthcare often result in higher costs for patients and reduced profit margins for payers. We enable healthcare organizations detect, avoid, and eliminate the risk of frauds by developing rule-based solutions using emerging technologies of predictive analytics to identify fraudulent patterns and flag potential frauds before claims are even paid. This preventive approach over a reactive one helps healthcare organizations save the time and effort incurred in fraud detection while driving enhanced patient outcomes.

We offer a comprehensive range of services for core administration platforms, including software design, development, implementation, quality assurance, upgrades, testing, and support for the TriZetto FACETS & QNXT. Trusted by more than 200 healthcare organizations, the TriZetto platform offers a complete suite of modules that empower payer organizations to meet their current business needs while preparing for future growth and adaptability. We are equipped with SMEs who specialize in FACETS & QNXT services, including Upgrades, Testing, Implementations, Migrations, Enrolment, System Analysis, and Batch Management, Maintenance, and Support. Our teams consist of senior members with backgrounds in TriZetto Facets and QNXT, enabling them to take full ownership of TriZetto platform customizations and implementations, claims analysis, batch monitoring, settlement, support, visualization, and more.

We aim to alleviate the burden of manual testing by implementing test automation based on key principles such as test data, case, and script reusability, automated generation of test data, and ensuring traceability between test cases and business requirements.

Focused on cost containment and efficient implementation, our integration services offer optimal solutions and best practices integrations, thereby enhancing operational efficiency and reducing timelines.

Formulary systems are used by healthcare organizations to effectively track, manage, and administer medications. Our team of experts helps healthcare organizations offer secure, cost-effective, and beneficial outcomes to patients by developing simple and efficient formulary systems based on extensive research and evidence. We cover all aspects of medication management, including lists of preferred drugs, policies for prescribing, administering, and utilizing medications, prescribing guidelines, information on the various uses of each medication, and guidelines on the usage of non-formulary medicine.

We provide effective ICD-10 services to facilitate a smooth transition, covering assessment, design, implementation, remediation, and testing phases. We offer ongoing support post-implementation, including assistance with any challenges encountered and continuous optimization to enhance operational efficiency in the long term.

Our team of healthcare domain & IT SMEs help healthcare organizations meet the changing needs of the healthcare industry by assuming full responsibility of their current project initiatives, working closely with their account management teams as an extended IT arm, while reducing operational costs. We have 24/7 on-demand experts and a dedicated recruitment support team.