Health Edge

HEALTH EDGE: HEALTH RULES PAYOR

HealthEdge HealthRules Payor & Coperor: unleashing the full potential of core administration

Integrated data management to drive operational excellence, comprehensive reporting, and strategic business intelligence. Combining Gaine Coperor with HealthEdge HealthRules Payor empowers healthcare organizations to achieve enterprise-wide data consistency – extending beyond the core administration platform to all interconnected systems. This unified data foundation is essential for maximizing efficiency, ensuring accurate reporting, enabling advanced analytics, and meeting rigorous compliance mandates.

The Challenge

HealthRules Payor is a powerful platform, but its effectiveness is directly tied to the quality and consistency of the underlying data. Organizations often struggle with data silos, inconsistencies, and manual workarounds to reconcile information from various sources. This impacts claims processing accuracy, provider data management, member services, and the ability to leverage HealthRules Payor's advanced analytics and reporting capabilities. Without a unified, trustworthy data foundation, achieving the full ROI of HealthRules Payor is challenging.

The Solution

Coperor's holistic data management platform delivers complete identity resolution across all critical healthcare data domains. It ensures data quality and synchronizes information – including administrative transactions and clinical data – seamlessly with HealthRules Payor. Coperor optimizes these key areas:

Extraction, Cleansing, and Standardization

Coperor connects to HealthRules Payor (and other relevant systems) via standard APIs and pre-built connectors (where available), extracting member, provider, claims, and related data. This data undergoes rigorous cleansing and normalization through Coperor's MDM capabilities, establishing a foundation of accuracy and uniformity.

Unified Identity Management

Coperor's advanced, healthcare-specific matching algorithms identify and resolve duplicate records and inconsistencies within HealthRules Payor data, and also across data from other connected systems (e.g., CRM, provider portals). This creates a single, authoritative view of each member, provider, and other key entities.

Data Augmentation and Verification

Coperor enriches HealthRules Payor data by incorporating external reference data (e.g., NPI, licensing) and information from other enterprise systems. This enhances data completeness and improves the accuracy of reporting and analytics.

Workflow Orchestration and Data Delivery

Coperor's Orchestrator manages the bi-directional flow of data between HealthRules Payor and other systems, providing real-time synchronization and updates. Coperor's Hub ensures this high-quality data is readily available to downstream applications and analytical tools, in the required format.

By deploying Coperor alongside HealthRules Payor, organizations achieve a quantum leap in data quality, operational streamlining, and system-wide performance. This translates to improved healthcare outcomes, reduced operational costs, and a stronger competitive advantage.

Summary

HealthRules Payor is designed to be the core of a payer's operations. To reach its full potential, it needs a foundation of clean, consistent, and connected data. Coperor provides that foundation.

The Coperor platform seamlessly integrates member, provider, claims, and other data from diverse sources, ensuring data quality before it reaches HealthRules Payor. During processing within HealthRules Payor, Coperor minimizes manual intervention through automated data preparation and validation. Most importantly, Coperor ensures that all systems consuming data from HealthRules Payor have access to consistent, reliable information in real-time. Coperor addresses these critical needs, empowering HealthRules Payor to function at its absolute peak.

This synergistic approach delivers significant benefits, including superior data quality, greater automation, enhanced reporting capabilities, and more insightful analytics. The resulting cost-effectiveness in running HealthRules Payor leads to increased profitability, reduced friction with members and providers, and optimized staff utilization.

Connecting Coperor is straightforward: integrate HealthRules Payor and other relevant systems managing member, provider, and claims data. This linkage establishes the mapping between your data ecosystem and the Coperor Ontology, allowing you to activate the necessary integration points and data management workflows.

The Benefits

Optimized Benefit Configuration and Management

HealthRules Payor's strength lies in its flexible benefit configuration. Coperor ensures the data underlying those configurations (member demographics, provider contracts, etc.) is accurate and consistent, maximizing the effectiveness of benefit administration.

Enhanced Claims Processing Accuracy

Coperor directly addresses a key challenge in claims processing: data quality. By pre-validating and reconciling member, provider, and claims data before it enters HealthRules Payor, Coperor significantly boosts auto-adjudication rates and reduces manual intervention.

Reliable Provider Data for Network Management

HealthRules Payor's provider data powers network management, contracting, and directory functions. Coperor offers a comprehensive solution for managing, updating, and governing this critical data, ensuring data quality to support accurate reporting, efficient network analysis, and up-to-date provider directories.

Streamlined Operations and Increased Automation

Coperor supercharges HealthRules Payor by providing a layer of intelligent data validation and quality checks. This enables organizations to maximize processing throughput, maintain exceptional data integrity, and achieve higher levels of automation.

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