U.S. Healthcare Payers’ Provider Data Management Applications Reviews and Ratings

What are U.S. Healthcare Payers’ Provider Data Management Applications?

A PDM application is a payer-industry-specific solution that helps payers’ IT and business teams. It also helps:

- Manage complex data combinations for in and out of network providers.

- Organize and manage required provider data by specialty types, business and legal entity structure, provider demographic information, and their affiliations to practice locations.

- Validate the demographic and contract data of providers for payer administrative purposes, such as provider directory creation, medical shopping tools and claims payments.

- Continually monitor provider data sources and alert healthcare organizations of provider data discrepancies and inaccuracies with data changes.

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InterSystems is a creative data technology company solving complex problems with extremely critical data in the healthcare, finance, manufacturing and supply chain sectors. The cloud-first data platforms solve scalability, interoperability, and speed problems for large organizations around the globe. InterSystems also develops and supports unique managed services for hospital EMRs, unified care records for communities and nations, and laboratory information management systems. InterSystems is committed to 24×7 support for customers and partners in more than 80 countries. Privately Heldly held and headquartered in Cambridge, Massachusetts, InterSystems has 25 offices worldwide.

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As a care access platform, Kyruus Health enables our partners to guide and match people to the appropriate care they seek. By creating connections across the healthcare ecosystem, we aim to support informed decisions and reduce friction leading to healthier outcomes. The end-to-end technology helps hospitals, health systems, payers, and medical groups deliver personalized care experiences for consumers. The data management system collects, streamlines, and organizes disparate data to power a range of capabilities for care delivery.

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Newgen is a company that specializes in providing a unified platform for digital transformation. This includes capabilities in process automation, content services and communication management. Its low code application platform is relied on globally, allowing businesses to develop and deploy complex, content-driven applications on the cloud. Newgen serves several uses cases across industries and is equipped to handle everything from onboarding to service requests and lending to underwriting, all in a fast and agile manner.

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Availity is focused on improving communication in the healthcare sector. The company develops an intricate network designed to aid in the transparent exchange of information among health plans, providers, and technology associates. As a leading health information network in the country, it assists in the execution of billions of clinical, administrative, and financial transactions every year. Availity's product suite is based on an intelligent platform that facilitates real-time collaboration, catering to the needs of a competitive, value-based care ecosystem.

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Availity is focused on improving communication in the healthcare sector. The company develops an intricate network designed to aid in the transparent exchange of information among health plans, providers, and technology associates. As a leading health information network in the country, it assists in the execution of billions of clinical, administrative, and financial transactions every year. Availity's product suite is based on an intelligent platform that facilitates real-time collaboration, catering to the needs of a competitive, value-based care ecosystem.

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CAQH, an organization with over two decades of experience, offers technology-enabled solutions that support health plans, providers, government entities, and vendors. It mainly focuses on the automation and predictability of business information exchange, making operations more efficient. Through its Committee on Operating Rules for Information Exchange (CORE), it engages players in the healthcare industry for unified information dissemination. Additionally, CAQH Insights conducts extensive research to identify and mitigate the strain of manual processes in healthcare administration.

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Constellation4 is a technology firm that specializes in health sector solutions. The organization's main focus lies in efficiently solving common operational challenges faced by health insurance companies and healthcare providers. Using Salesforce Health Cloud, Constellation4 develops a comprehensive range of products tailor-made to aid in effective health management. The products range from a physician-to-physician referral platform aimed at increasing market share and patient status visibility to Provider Network Management and Provider Data Management solutions that streamline payer-provider workflows and ensure data accuracy. Additionally, Constellation4 also offers healthcare analytics that matures data science, predictive analytics, and AI processes. Use cases include but are not limited to claims reconciliation, profitability analysis, and campaign management.

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Gaine's Coperor Health Data Management Platform (HDMP) is a unified data platform with master data management (MDM) at its core. It integrates diverse healthcare data sources, including provider, patient, claims, and clinical information, into a single, longitudinal entity profile. Coperor supports and extends traditional interoperability standards like HL7 and FHIR with a robust health data model, millisecond performance, and the ability to preserve semantic context for analytics. MDM, capabilities including, matching, merging, and cleansing capabilities with reference data, cell-level survivorship, ability to automate complex business rules, reference data management, and a complete audit trail.

Coperor breaks down data silos for enhanced operational excellence, real-time data delivery across hybrid and multi-cloud environments, and optimized performance in terms of speed, cost, and quality of data management.

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Infosys is a company concentrated on providing digital services and consultation on a global scale. Originating from over 30 years of managing the infrastructures of significant global corporations, Infosys guides businesses through their digital transformation process. This is achieved by reinforcing the organization with an AI-controlled center that aids in outlining the implantation of modifications and by enhancing the industry with scalable agile digital. This approach aims to deliver unprecedented levels of organizational efficiency and consumer satisfaction. Furthermore, Infosys places a strong emphasis on continual learning to promote regular enhancement through the cultivation and transfer of digital proficiency, knowledge, and notions derived from its innovation ecosystem.

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LexisNexis Risk Solutions is a multi-industry company comprising seven brands. It utilizes innovative technologies, information-based analytics, decision tools, and data management services to aid its customers in problem-solving, informed decision making, compliance, risk reduction, and operation improvement. The brands comprising LexisNexis Risk Solutions cater to different sectors which include aviation, agriculture, chemical and energy, financial services, collections and payments, commercial property, corporations and non-profits, government and law enforcement agencies, healthcare, human resources, insurance, and tax. These brands process data and develop technology solutions to generate insights that can help businesses and government entities. The company is headquartered in Atlanta, Georgia, with offices situated worldwide, and is a part of RELX, which delivers information-based analytics and decision tools for professional and business customers on a global scale.

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LexisNexis Risk Solutions is a multi-industry company comprising seven brands. It utilizes innovative technologies, information-based analytics, decision tools, and data management services to aid its customers in problem-solving, informed decision making, compliance, risk reduction, and operation improvement. The brands comprising LexisNexis Risk Solutions cater to different sectors which include aviation, agriculture, chemical and energy, financial services, collections and payments, commercial property, corporations and non-profits, government and law enforcement agencies, healthcare, human resources, insurance, and tax. These brands process data and develop technology solutions to generate insights that can help businesses and government entities. The company is headquartered in Atlanta, Georgia, with offices situated worldwide, and is a part of RELX, which delivers information-based analytics and decision tools for professional and business customers on a global scale.

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LexisNexis Risk Solutions is a multi-industry company comprising seven brands. It utilizes innovative technologies, information-based analytics, decision tools, and data management services to aid its customers in problem-solving, informed decision making, compliance, risk reduction, and operation improvement. The brands comprising LexisNexis Risk Solutions cater to different sectors which include aviation, agriculture, chemical and energy, financial services, collections and payments, commercial property, corporations and non-profits, government and law enforcement agencies, healthcare, human resources, insurance, and tax. These brands process data and develop technology solutions to generate insights that can help businesses and government entities. The company is headquartered in Atlanta, Georgia, with offices situated worldwide, and is a part of RELX, which delivers information-based analytics and decision tools for professional and business customers on a global scale.

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LexisNexis Risk Solutions is a multi-industry company comprising seven brands. It utilizes innovative technologies, information-based analytics, decision tools, and data management services to aid its customers in problem-solving, informed decision making, compliance, risk reduction, and operation improvement. The brands comprising LexisNexis Risk Solutions cater to different sectors which include aviation, agriculture, chemical and energy, financial services, collections and payments, commercial property, corporations and non-profits, government and law enforcement agencies, healthcare, human resources, insurance, and tax. These brands process data and develop technology solutions to generate insights that can help businesses and government entities. The company is headquartered in Atlanta, Georgia, with offices situated worldwide, and is a part of RELX, which delivers information-based analytics and decision tools for professional and business customers on a global scale.

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LexisNexis Risk Solutions is a multi-industry company comprising seven brands. It utilizes innovative technologies, information-based analytics, decision tools, and data management services to aid its customers in problem-solving, informed decision making, compliance, risk reduction, and operation improvement. The brands comprising LexisNexis Risk Solutions cater to different sectors which include aviation, agriculture, chemical and energy, financial services, collections and payments, commercial property, corporations and non-profits, government and law enforcement agencies, healthcare, human resources, insurance, and tax. These brands process data and develop technology solutions to generate insights that can help businesses and government entities. The company is headquartered in Atlanta, Georgia, with offices situated worldwide, and is a part of RELX, which delivers information-based analytics and decision tools for professional and business customers on a global scale.

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MacroHealth is a company that concentrates on simplifying the purchasing and offering of healthcare services. The primary business problem the company resolves is optimizing healthcare pricing and payments by providing a Marketplace-as-a-Service platform. The platform is geared towards Payers, Providers, and Health Market Partners to streamline and interconnect their unique healthcare ecosystems. The Optimization solutions offered by MacroHealth focus on analytics and connectivity. They provide Payers with data improvement, analytical instruments, and market benchmarking to develop Provider network solutions that are customized for every unique member group. With their Connect solutions, a single EDI/API implementation is sufficient to establish a connection with chosen Providers, Provider Networks, and industry Partners. The overarching goal is the creation of Intelligent Health Markets to significantly improve healthcare cost, quality, and access.

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Founded in 1998, Milliman MedInsight is a provider of healthcare data and analytics for payers, providers/ACOs, employers, and government agencies. Our comprehensive suite of analytics and data solutions empowers organizations to leverage healthcare data for informed decision-making and improved clinical and financial outcomes. With deep industry expertise and advanced technology, we deliver actionable insights into healthcare utilization, costs, quality, and performance. From risk management to value based care, Milliman MedInsight empowers stakeholders to navigate the complexities of the healthcare landscape and achieve sustainable success.

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NTT DATA is an established global IT services provider that has its operations spread over 50 countries, with its main operations centered in Tokyo. The main industry problem that it seeks to address is the need for technological innovation. To this end, NTT DATA works towards creating better solutions for day-to-day life by connecting people. Its broad range of services includes consulting, application, business process, cloud, and infrastructure services that cater to both businesses and governments across the globe. The company's unique culture, which has evolved over the past five decades, emphasises on being people-oriented and focusing on getting the small details right, with the aim to make a significant impact globally. This culture combines the influence of a global brand with the dynamism and passion typically associated with entrepreneurship.

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PRIME is focused on providing a comprehensive data validation solution that can be seamlessly integrated into Health Plans and Health Systems/Provider Groups. The main goal of the company is to enhance data accuracy and maintain it at an optimal level. Through a blend of innovative technology and expert staff, PRIME conducts direct outreach to providers for data verification purposes. Its services include comprehensive and high-quality data that meets compliance standards and also ensures exceptional member experience. In terms of service offerings, PRIME provides online provider directories, provider training, and immediate access to directories for members.

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Perspecta’s provider data solutions help payers, workers’ compensation organizations, and government agencies maintain accurate, compliant provider information. By leveraging AI and automation, Perspecta streamlines data verification, cleansing, and updates to reduce errors and improve efficiency. These solutions support regulatory compliance, including requirements under the No Surprises Act, while optimizing provider networks to ensure adequacy and accessibility. With a focus on accuracy, Perspecta helps organizations enhance claims processing, network management, and regulatory adherence, reducing administrative burdens and improving provider data integrity.

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Perspecta’s provider data solutions help payers, workers’ compensation organizations, and government agencies maintain accurate, compliant provider information. By leveraging AI and automation, Perspecta streamlines data verification, cleansing, and updates to reduce errors and improve efficiency. These solutions support regulatory compliance, including requirements under the No Surprises Act, while optimizing provider networks to ensure adequacy and accessibility. With a focus on accuracy, Perspecta helps organizations enhance claims processing, network management, and regulatory adherence, reducing administrative burdens and improving provider data integrity.

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