Yes. Virtusa has many healthcare payer technology solutions that can help payers address problems like provider management, financial transparency, claims denials, gaps in patient care, and unstructured data. Virtusa’s solutions help payers transform the customer experience, drive innovation, and increase utilization. Payers can provide meaningful services and simplify healthcare delivery at a reduced cost. Example solutions include:

Healthcare AnalyticsToAction: Payers can leverage data-driven insights to evaluate physician performance, improve care management, and deliver accurate information to employers.
Pega Smart Claims Engine (SCE): Payers can replace legacy claims platforms and make the claims process more efficient with advanced analytics, microservices, cognitive computing, blockchain, and machine learning.
Reimagining Omni-Channel Communication Experience for Payers: Payers can optimize payer-provider communication with machine learning and conversational AI for fast, accurate, and consistent customer service across channels.
Simplify Appeals & Grievances Processing: Payers have simplified case management of the appeals and grievance process with guided workflows powered by machine learning.
InsightsToCare: Payers have access to a commercial database of de-identified patient medical data that lists provider performance across cost and utilization. Cloud analytics deliver advanced insights into care management programs, clinical outcomes, cost of care plans, and claims fraud.
CMS Interoperability and Patient Access Solution: Payers gain CMS interoperability, improving real-time access to claims information. Fast Healthcare Interoperability Resources (FHIR) and HL7 formats modernize healthcare IT systems for quicker access to healthcare records and advanced data exchange, giving payers a holistic view of provider information.
HealthConnect: Payers can create better health plans with improved access to patient health status. Patient health can be monitored with decision aids, digital health platforms, and wearables. Providers can track patient symptoms and health measurements using connected devices, assisting payers in collecting essential health data.

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