Payer Services

CareVista, secure cloud-based Platform as a Service, with integrated patient records and end-to-end technology modules
Population Health Suite with patient identification and targeting using CareSync proprietary logic for revenue maximization and improving quality performance metrics and care gaps
Value-based contracting design, monitoring and reconciliation
Population health management intervention program design, implementation and continuous KPI measurement
Identification of social determinants of health to improve health equity
Tracking and assessment of quality and performance metrics
Fraud and abuse evaluation and outlier analysis of claims billing and payments
Reconciliation and auditing of appropriate capitation premium payments
Provider profiling with clinical management and treatment guideline compliance evaluations
Data exchange and integration application tools
Health outcomes and pharmacoeconomic research and publications
Clinical criteria development for utilization management and prior authorizations
PBM contract review and pricing/rebate audits
Design, training and implementation of care coordination programs with case managers
Comprehensive population and geographic mapping using medical and drug claims to identify patients and providers for targeted intervention programs
Technology and vender evaluations and oversight
Expert RFP/ITN response and reviews
Regulatory and policy analysis and evaluation