Payers. Providers. It’s What we do.

Client Testimonials

“I have worked with Larry Hodge, president & CEO of HealthTECH, and his team for almost my entire career. He takes time to hire only the best candidates and it shows in their tenure and quality of talent. Unlike larger providers who throw numbers and hope for the right fit, HealthTECH brings a much more customer-focused approach to finding resources and ensuring successful engagement. I will continue to partner with HealthTECH no matter where my career takes me.”

Jim Berlinger

Sr. Manager of Application Development

Healthfirst Florida

“HealthTECH is a detail oriented company that understands that hiring the right candidate for a career position for your organization is the most important factor for success. They will provide you outstanding service, qualified candidates with industry experience and ongoing communication to ensure you are extremely satisfied.”

 

Joe Gallo

VP, Health Plan

CVS Health

Managed Care: Healthcare Payer Solutions

Our network contains unsurpassed experts with in-depth knowledge about the following technologies.

Epic Tapestry

This software is named after the intricately woven textile that weaves individual strands together in complex ways to create a unified whole. That’s because the Epic Tapestry module—one of the earliest, most foundational modules in the Epic system—seamlessly joins together healthcare workflows: from health insurance eligibility and integration to efficient enrollment, and from referrals and authorizations to CRM functions.

This module also allows your facilities to handle claims management, patient billing, accounts payable functions, contracting, utilization management, adjudication, and more.

You can connect directly to government systems through this technology from enrollment to completion of services. Your team can leverage the power of Epic Tapestry to manage risk as you meet plan requirements for Medicare Advantage along with marketplace insurance policies.

The Tapestry module, like other technologies in the robust Epic EHR application, can be implemented, integrated, and optimized in customized ways to meet the unique operational needs of your healthcare organization.

HealthEdge HealthRules

HealthRules Payor transforms the ability of healthcare organizations to administrate a broad spectrum of health plans. What makes this technology unique and especially powerful is the patented HealthRules Language™ that allows the application to “understand” English vernacular. Your facilities will benefit from this as the technology intuitively allows rules and terms of health plans to be easily understood by any user while also being updated more easily.

This means that complex custom coding and intricate system configurations can now be part of the past as healthcare legacy systems are replaced with HealthEdge HealthRules. Once that system is integrated into your organization’s technology, you can quickly innovate with agility. In short, HealthRules allows business logic to be clear to people across departments, not just to those in your IT department.

Benefits of HeathRules include a new way to configure your healthcare facility operations and then operate them efficiently and well. Through this new way of leveraging healthcare payer solutions, your organization becomes more resilient, even when changes occur. That’s because of the ease of upgrading and your ability to have transparent insights into actionable information.

MHK Market Prominence

To optimally manage processes for Medicare Advantage and Part D (MAPD) members, your healthcare facilities can leverage the power of Market Prominence, This modern application will take your team from enrollment to member services to premium billing; seamlessly guide your financial team through highly effective, sophisticated account reconciliations; and maximize your overall revenue.

Centers for Medicare and Medicaid (CMS) requirements can be quite complex with the Market Prominence application allowing your teams to thoroughly address each item in your workflows and processes as efficiently as possible.This allows your healthcare organization to remain in compliance while providing unsurpassed timely service to your Medicare patients.

Go beyond the billing to reconciliation cycle with this modern managed payer solution by also using Market Prominence to forecast expected CMS compensation to the penny. This allows you to manage organizational cash flow, confident in your assessments because this application is continually updated with the latest CMS information: from demographics to risk factors and more. When reimbursements arrive, you can easily compare your forecasts to actual amounts paid, and quickly and easily correct any discrepancies.

TriZetto Facets

Healthcare facilities use Facets to automate processes across the organization to streamline operations, lower costs, and enhance reliability. This healthcare payer solution takes users from claims processing to billing, allowing you to manage and optimize your workflows and processes. You can customize and configure this robust solution to dovetail with your precise requirements and to mesh with your business rules—while keeping your organization aligned with government regulations and mandated updates.

Upgrading to Facets from a legacy system can digitally transform your healthcare payer processes by modernizing your technology. Benefit from this powerful application by optimizing its implementation and integration into your organization’s overall IT system.

TriZetto QNXT

This robust claims management technology allows your healthcare organization to automate processes and streamline your claims process. You can use this application to prioritize your outstanding claims inventory and then expedite your pending ones from Medicare, Medicaid, and other insurers. This software handles billing management effectively and well, efficiently and accurately collecting revenue to enhance cash flow and your facilities’ bottom line.

As with all of the other healthcare payer solutions described on this page, QNXT can be optimally implemented, integrated, and optimized to precisely meet the requirements of your organization.

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