Health Plans and Payers

Delivering the value-based future today.

Clearinghouse + EDI

Cost Control Meets Quality Outcomes

Tap Into the Power of Veradigm

Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.

Solutions from Veradigm can help you:

  • Deliver insights to drive quality outcomes cost-effectively
  • Improve efficiency for you, your providers, and your members through high-speed clinical data exchange
  • Positively impact point-of-care decision making by integrating payer guidance and prior authorization management directly in each healthcare provider’s existing workflow
Young doctor sitting down with older patient pointing to health records on a tablet

Clinical Data

eChart Courier™ Streamline medical chart retrieval

  • Save time, cost, and resources by retrieving medical charts electronically
  • Support data collection for Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) 5-Star quality reports
  • Send information in a secure format for use by only intended users, in accordance with Health Insurance Portability and Accountability Act (HIPAA) rules Request More Information About eChart Courier™

Veradigm Payer Insights Helps payers to Improve outcomes for patients and minimize risk appropriately, including those related to RADV

  • Enhance performance on key quality measures like HEDIS scores and STAR ratings
  • Satisfy provider demand for alerting that is integrated into their existing daily workflow

For more detail, please go to Veradigm Payer Insights.

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Risk Adjustment & Quality Management

Risk Adjustment & Quality Analytics Deliver advanced solutions for risk and quality management

  • Assist finance, medical management, managed care, quality management, and case management teams in risk analysis
  • Translate analytics into action with the help of our experience in risk adjustment, quality management, and provider engagement

For more information, contact us.

Looking to learn more about Health Plan and Payer solutions?

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Related Insights, News, and Events

Speak with Veradigm today to request a demonstration or for more information on how we can help you meet your goals

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