Health Plans + Payers
Closing care gaps is essential for both successful patient outcomes and boosting revenue. Missed screenings, incomplete documentation, and abandoned prescriptions create challenges that risk patient health and leave financial opportunities on the table. Veradigm addresses these challenges with a method that combines prospective services, real-time alerts, and active collaboration.
Veradigm’s Gap Closure Services—powered by our CORE Program (Comprehensive Outcomes Realization and Engagement)—support providers in taking gap closure to the next level by delivering services to identify, close, and document care gaps for your network providers, helping your health plan realize improved patient outcomes and additional revenue.
Veradigm Payer Insights integrates patient-specific care gap alerts directly into the EHR workflow of your network providers. It delivers real-time, actionable insights to help them identify and address care gaps immediately, improving care, streamlining operations and reducing administrative overhead:
Veradigm Collaborate increases provider engagement by facilitating communications and lowering alert fatigue. Here’s how it provides your team with actionable, prioritized insights:
Together, these three pillars create a powerful strategy that promotes care quality, raises operational efficiency, and amplifies revenue recovery. From detection to intervention with Veradigm’s Gap Closure solutions, every step is automated to support superior patient outcomes and financial performance.
Balancing superior patient care with cost control is an ongoing challenge for healthcare payers. Our integrated risk adjustment solutions convert complex clinical and financial data into actionable insights that align finance, medical management, and actuarial teams. They also support clinical quality and secure financial sustainability in today’s value-based care environment.
Convert complex clinical and financial datasets into clear, actionable insights. Our Risk Adjustment Analytics offers precise scoring, predictive insights, and live oversight to help your teams pinpoint intervention opportunities and optimize risk management strategies across multiple care markets.
Develop a broad view of member health by incorporating non-medical drivers (NMDoH) into your strategy. Our Health Equity approach uses demographic and socioeconomic data to uncover hidden disparities, so you can design targeted interventions for meaningful population health outcomes.
Gain crucial visibility into emergency department trends to understand cost pressures and service inefficiencies. With our Emergency Department Utilization solution, you can monitor usage patterns, reduce wasteful spending, and inform strategic network improvements that improve overall care quality.
Shield your organization from the financial fallout of data validation audits with proactive risk management. When our Risk Mitigation solution identifies high-risk conditions and providers, it delivers actionable alerts that help you take preemptive measures and safeguard your financial health.
Secure the entire encounter submission process with complete visibility and control. With our Comprehensive Submissions solution, every claim is accurately processed and compliant. This reduces errors, eases administrative burdens, and expedites reimbursement.
Modern healthcare hinges on drawing on accessible, accurate data and converting it into actionable intelligence. Veradigm’s integrated suite redefines how medical charts are retrieved, coded, and analyzed. It delivers faster results, improved accuracy, and actionable insights for smarter, more efficient care across your network.
Imagine eliminating the cumbersome manual process of “chart chasing.” eChart Courier automates medical chart retrieval and delivery and is used by more than 300,000 healthcare providers to send and receive charts in a secure electronic format. It helps health plans and providers:
eChart Courier redefines the chart retrieval process and maximizes clinical data exchange to pave the way for rapid decision-making and better patient outcomes.
Veradigm eChart Coder employs advanced technologies—such as Natural Language Processing (NLP), Machine Learning (ML), and Optical Character Recognition (OCR)—to identify, document, and code patient conditions with precision. Built for coders by coders, it uses a two-stage coding engine:
This computer-assisted coding engine pre-populates charts to give your staff a head start, focuses on critical dates of service, and orchestrates an intuitive, “easy-flow” code entry process. Engineered to support multiple submission types and scale effortlessly, eChart Coder:
Coordination between healthcare payers and providers hinges on the rapid, accurate, and secure exchange of clinical data. eChart Integration and Analytics automates the extraction of clinical information from diverse EHR systems using HL7® FHIR® standards. It turns raw, machine-readable data into human-friendly, coder-ready formats to pave the way for better quality analytics and risk adjustment. Key benefits include:
eChart Integration and Analytics brings together diverse data sources into a centralized repository. This consolidation minimizes administrative burdens, reinforces gap closure strategies, and improves the precision of claims validation processes.
Quality is the cornerstone of effective healthcare. We don’t just detect gaps; we give you the tools to act decisively. Veradigm’s Quality Analytics converts diverse data sets into clear, actionable insights that help health plans uncover unmet care needs in medical, dental, pharmacy, and additional benefit areas. These insights then ignite significant improvements in performance.
Our platform is an NCQA Certified HEDIS® Vendor™, supporting performance across HEDIS, Quality Rating Systems, Star Ratings, and more. It delivers improved patient outcomes and maintains strict regulatory compliance.
Veradigm Payer Analytics offers a unified solution that marries risk adjustment with quality management in a single workflow. It’s an vital process that creates complete transparency across your risk adjustment, quality, and pharmacy programs to maximize financial performance and clinical outcomes.
Veradigm’s unified suite covers every critical function—from finance and actuarial operations to clinical management. It offers the tools your risk adjustment and quality management programs need to provide measurable improvements in care and efficiency.
Future-proof your risk adjustment and claims by unifying disparate data flows into a single, efficient gateway. Veradigm Payerpath’s EDI Gateway leverages decades of payer expertise to simplify electronic data interchange (EDI) challenges—enabling smoother operations and reducing the risk of costly errors.
With Veradigm Payerpath’s EDI Gateway, your organization can manage EDI complexity with increased accuracy and operational efficiency. Stay ahead in risk adjustment and claims processing—ensuring every transaction drives stronger performance in today’s healthcare landscape.
Enhance Risk Adjustment:
Secure maximum reimbursement by capitalizing on advanced analytics to fine-tune risk scoring.
Accelerate Cost Efficiency:
Modernize claims processing and operational workflows to reduce waste and raise financial performance.
Improve Member Outcomes:
Turn real-time data into actionable insights that help increase care quality and overall member health.
Unify Payer Operations:
Integrate disparate data sources for an efficient workflow that supports smarter decision-making.
