U.S. Healthcare Payers’ Core Administrative Processing Solutions (CAPs) Reviews and Ratings

CAPS are a critical tool for U.S. healthcare payer business enablement, consisting of software and services that support health insurance administration and transaction processing. These solutions historically reside at the center of payer architecture, serving as the system of record for claims and, in many cases, for member enrollment, premium billing and provider fee schedules as well. CAPS tend to be the most significant technology investment payer CIOs make, not just in the initial purchase, but on an ongoing basis as they are expensive to operate and maintain. Once implemented, CAPS is a sticky solution, with an average tenure within a payer environment easily exceeding a decade. As such, CIOs must ensure that the CAPS selection has the scalability, extensibility and adaptability to reliably perform in a rapidly evolving market climate rife with uncertainties. In this way, they will unlock the value of reduced manual and rework costs, decreased operational risks, and improved flexibility to meet market demands and increase revenue.

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