Payer Solutions

No More Distractions – focus on your business and let us manage your terminology needs

Ensuring financial, operational, and clinical accuracy in an evolving landscape of standards and interoperability challenges.

From claims processing and benefits management to analytics and population health management, payers depend on numerous administrative codes and clinical terminologies (ICD-9, HCPCS, CPT-4, NDC) throughout the enterprise. As standards and reimbursement policies change, such as with the ICD-10 mandate and the rapid adoption of terminologies such as SNOMED CT®, LOINC, and RxNorm, payers face significant financial, operational, and medical management hurdles in regard to accurately incorporating these updates in a timely manner — and keeping them relevant to the rules already established.

Deploy a single source of truth for standard and local content

Use code groups to represent clinical concepts and business rules

Stream content updates on demand

Automatically map local terminologies to standards

Model and create custom mappings to standards

Normalize unstructured data

Leverage our library of provider & consumer friendly synonyms

Enable simple text terminology search

Easily integrate terminologies into clinical applications

Analyze DRG shifts & prioritize CDI

Model scenarios to understand revenue impact

Generate test data for end-to-end testing

Content Standardization

Ensure enterprise systems are aligned with terminology standards

  • Clinical Measures
  • Cohort Identification Rules
  • Quality Indicators
  • Medical Benefit Policies

Data Normalization

Harmonize data from disparate sources into standard terminologies

  • Semantic Interoperability
  • HIE & ACO Enablement
  • Data Warehousing
  • Analytics and Population Health

Workflow-Enhancing Search

Abstract complex terminologies from end users

  • Provider Portals
  • Explanation of Benefits
  • Broker Portals
  • Consumer Call Centers
  • Consumer Portals
  • Provider Call Centers

ICD-10 Remediation

Mitigate financial risk in an evolving landscape of terminology standards

Identify areas that pose the greatest financial risk in an ICD-10 world - enabling the prioritization of provider testing & contracting strategies.

The Health Language Enterprise Terminology Management Platform

Our platform provides you with the software, content, and consulting solutions that map, translate, update, and manage standard and enhanced clinical terminologies on an enterprise scale — enabling the information liquidity required to support some of healthcare's toughest challenges, such as meaningful use compliance, ICD-10 conversion, population health management, analytics, ACOs, and semantic interoperability among systems.