2023 Best In KLAS Claims & Administration Platforms (Payer)

SKYGEN aims to transform benefits management and administration for specialty payers to reduce costs and increase satisfaction for all involved. Currently focused on dental and vision payers, SKYGEN offers a variety of technology to fill all common core administration needs. All solutions are available as a SaaS platform or through SKYGEN’s third-party administrator (TPA) model. This report examines the SKYGEN customer experience.

The complexity of benefits administration can draw focus away from improving health and wellness opportunities for health plan participants. Viveka Health’s benefits administration solution aims to help by integrating all functionality required to administer benefits into one comprehensive platform, allowing payers to communicate, manage claims, and analyze data all in one place. This report explores the experiences of six unique Viveka Health customers and their satisfaction with the platform.

Claims data from payer organizations can give providers a more comprehensive view of a patient’s clinical history and thereby improve the quality of care they are able to deliver. Yet incorporating this information at the point of care can be expensive and challenging. To tackle this problem, the collaborators in this project worked to map the payer organization’s claims data so that it could be incorporated into provider workflows in real time at the point of care.

Performance

CMS Payer Interoperability 2022

13 September 22 | Joe VanDeGraaff and Ruirui Sun

CMS recently issued a new regulation stipulating that CMS-regulated payers must be able to securely store and share patient data under the HL7 FHIR standard. To achieve this, organizations use CMS payer interoperability products, which usually provide capabilities such as patient access APIs, provider directory APIs, and payer-to-payer data exchange. Health plans and state agencies are evaluating how well technology vendors’ existing or newly developed solutions can help them stay compliant with the new CMS requirements. This report is KLAS’ first to validate the purchase decisions and customer experience of some of the vendors in this area.

Company/solution	Overall performance score (100-point scale)	Total evaluations	Trend (2022-2023)	Culture	Loyalty	Operations	Product	Relationship	Value

HealthEdge HealthRules Payer	76.6	n=20	-2%	D+	B	C+	C+	C+	C-

Cognizant Trizetto Core Claims/Administration Solutions	66	n=26	-7%	D	D+	C-	C-	D+	F
	50.0	100.0

Company/solution	Trend (2022-2023)	Culture	Loyalty	Operations	Product	Relationship	Value

HealthEdge HealthRules Payer 76.6 n=20 COMMENTS	-2%	D+	B	C+	C+	C+	C-
Cognizant Trizetto Core Claims/Administration Solutions 66 n=26 COMMENTS	-7%	D	D+	C-	C-	D+	F

Company/solution	Overall performance score (100-point scale)	Total evaluations	Culture	Loyalty	Operations	Product	Relationship	Value

Advantasure Core Administration Solutions [C] C	75.2	n=6	C	C+	C+	C+	C+	C-

athenahealth athenaIDX Financial Risk Manager * [C] L C	76.2	n=4	B	C+	B-	C	C	C-

Epic Tapestry [C] C	81.3	n=22	B-	B	B	B-	B	B-

SS&C Health DST Health Solutions Core Claims/Administration Solutions * L	63	n=7	F	D-	D	D+	C	D+

Company/solution	Overall performance score (100-point scale)	Total evaluations

Advantasure Core Administration Solutions [C] C culture C loyalty C+ operations C+ product C+ relationship C+ value C-	75.2	n=6

athenahealth athenaIDX Financial Risk Manager * [C] L C culture B loyalty C+ operations B- product C relationship C value C-	76.2	n=4

Epic Tapestry [C] C culture B- loyalty B operations B product B- relationship B value B-	81.3	n=22

SS&C Health DST Health Solutions Core Claims/Administration Solutions * L culture F loyalty D- operations D product D+ relationship C value D+	63	n=7

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