Healthcare Payers

You know the obstacles that come with processing a large number of claims and overseeing critical administrative functions. Manual processes, complex coding systems, and error-prone workflows can lead to delays, errors, and increased administrative costs.

Learn how ClearDATA streamlines and automates your most critical processes, prevents fraud and more.

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You rely on accurate data to make informed decisions about coverage, pricing, and risk assessment. However, ensuring data accuracy and quality from various sources, such as healthcare providers or pharmacy benefit managers, can be a significant challenge. Meanwhile, you also need to detect and prevent fraudulent activities, such as false claims or identity theft while complying with a wide range of compliance regulations and adapting to changing healthcare policies.

Here’s how ClearDATA works for you:

Reduce Inefficiencies

Data Accuracy

Fraud Detection

Regulatory Compliance

Claims processing and administrative inefficiencies:

Use our managed services to help you streamline claims processing and reduce administrative inefficiencies. We provide you the automation tools, workflow optimization, and data analytics capabilities to improve your claims management processes.

Data accuracy and quality:

With our CyberHealth™ platform, ensure data accuracy and quality through robust data governance and monitoring, offering data validation, data quality controls, and analytics capabilities to ensure you have access to reliable and accurate data for decision-making.

Fraud detection and prevention:

Both our platform and managed services offer fraud detection and prevention with advanced analytics, anomaly detection, and monitoring capabilities to identify potential fraudulent activities and protect payers against fraudulent claims.

Regulatory compliance and changing healthcare policies:

We help you stay up to date with changing healthcare policies, compliance, and regulatory requirements. Our managed services include compliance monitoring, risk assessments, policy development, and audit support, helping payers navigate complex compliance landscapes effectively. We help you implement necessary updates, conducting regular assessments, and ensuring adherence to compliance standards across different regions and regulations. In fact, through our Business Associate Agreement (BAA), we will take on the responsibility of configuring HIPAA eligible services and HITRUST compliance for you.