Payers & Managed Care

Data-Driven Solutions for Payers & Managed Care Organizations

Health plans and managed care organizations face intense pressure to control costs, meet CMS interoperability mandates, and deliver value-based care programs that actually improve member outcomes. infoHealth Systems provides the IT and analytics expertise to make it happen.

CMS Interoperability Compliance

Patient Access API, Provider Directory API, and payer-to-payer data exchange implementation to meet the CMS Interoperability and Prior Authorization Final Rule.

Claims & Clinical Analytics

Unified claims and clinical data platforms that power risk stratification, HEDIS measurement, and care management program targeting.

Prior Authorization Automation

Electronic PA implementation using FHIR-based Clinical Decision Support Hooks and SMART on FHIR apps to streamline provider and plan workflows.

Member & Provider Portals

FHIR-based member-facing and provider-facing data access portals that meet regulatory requirements and improve satisfaction.

Value-Based Programs

IT architecture and analytics to support ACO, shared savings, and pay-for-performance programs with your provider network.

Data Governance

Master member index, provider directory management, and data quality programs that make your analytics trustworthy and actionable.