Payers

With 2,100 payer connections reaching nearly all United States government and commercial payers, our solutions help you enhance member engagement, improve quality outcomes, manage healthcare costs, and improve operational efficiencies across the member journey.

Our Intelligent Healthcare Network™ is one of the largest healthcare financial and administrative networks in the United States. We processed over 12 billion healthcare-related transactions, covering over $2 trillion in claims and touching one in five United States patient records in fiscal year 2016. We have developed our network of payers and providers over 35 years and connect to the vast majority of private and government payers and claim-submitting providers in a hybrid cloud-based, user-centric and secure infrastructure environment.

For government-sponsored and commercial payers, we offer value-based payment solutions, including member engagement, risk-adjustment, quality management and bundled payment analytics, that support more than 50 million members, including Medicare Advantage plans and the top Managed Medicaid plans.

Delivering Proven Performance

Cigna is using our payer solutions to deploy new payment and product strategies and transition to value-based care/value-based reimbursement.

Partnering with Blue Cross and Blue Shield of Arizona, we have formed a new company, ACO Partner, delivering a broad range of services to help healthcare providers succeed in today's value-based environment. Participating providers will have access to shared savings opportunities with partnering payers that will provide incentives for greater efficiencies and improvements in the quality of care.

Solution Areas

  • Clinical Claims Management
  • Communications & Payment Services
  • Consulting
  • Data Analytics
  • Decision Management
  • Engagement Solutions
  • Network & Financial Management
  • Network Solutions
  • Payment Integrity
  • Payment Solutions
  • Pharmacy Benefits Solutions
  • Quality Performance
  • Risk Adjustment
  • Value-based Care