Payer Solutions
Optimize Payer Operations and Outcomes
We help payers maximize the value of technology investments to enhance provider relationships, boost member satisfaction, improve financial performance, and ensure compliance.
Together, we help you realize the full potential of your investments.
Tegria’s Payer Solutions
Tegria provides comprehensive, payer solutions to help you utilize data to guide strategy, improve insights, and elevate outcomes. Our healthcare expertise spans technology vendors, systems, and regulations to provide payers with highly valuable insights and customized strategies. We guide you through IT system selection, implementation, and optimization while addressing challenges that get in the way of your goals.
I have representatives from Tegria, and they are just amazing.
The partnership is great. In each specific area, whether it be EDI technical analysis, business analysis, or data governance, the firm has always delivered on their outcomes.
DIRECTORNovember 2024, Payer IT Consulting Services, KLASresearch.com
Advisory Consulting Services
We provide expert guidance, from strategic advisory consulting to planning services, tailored to the unique needs of health plans.
- IT and Operational Assessments
- Strategic Planning
- System Procurements
- Digital Transformation
- Payer / Provider Collaboration
Ranked #2 in Payer IT Consulting
Technology Services
Our team employs multiple approaches to evaluate, understand, design, and implement changes to optimize your operations and systems.
- Implementation and Optimization
- Custom Development and Maintenance
- Project Management
- Staff Augmentation
- Core Claims
- Population Health
Payer-Provider Integration
We help facilitate effective payer-provider collaboration, ensuring smooth operations and enhanced data exchange, while enabling all parties to achieve their goals.
- CMS Mandates
- Data Management and Analytics
- Epic Payer Platform and Tapestry
- Interoperability Requirements
- Clinical Data Exchange and Data Integration
As a whole, we were extremely pleased with the results that we got from our engagement with Tegria, especially when looking at the overall return on the investment…
DIRECTOROctober 2025, collected by KLAS Research
Operations + Delivery Transformation
We equip clients with practical payer solutions, experience-based strategies and tools to enhance operations and execution across the enterprise. Immersing ourselves in your organization, we help you design and implement a data-driven operating model with a unified approach that aligns your teams with your strategic objectives.
- Enterprise Transformation
- Operating Model Design Strategy + Execution
- Lean Portfolio Management
- Scaled Agile Frameworks
- Change Management
The Tegria Difference
Healthcare Focus
Our exclusive healthcare focus fosters thriving partnerships and deep knowledge across technology and operations.
Vendor Experts
As a vendor-neutral firm, we have deep knowledge of leading health IT systems to help payers find the right fit.
Integrated Perspective
With deep experience across provider and payer organizations, we foster collaboration for well-integrated operations.
Expertise Across Platforms + Tools
- Facets
- GuidingCare
- HealthFolder
- HealthRules
- JIVA
- Healthedge
- Plexis
- Epic
- ServiceNow
- NetworX Pricer
- Payer Platform
- QNXT
- Epic Tapestry
- Cognizant
- ZeOmega
- Conduent
- VBA
- HealthTrio
Let’s Connect
Our team is driven by passion, committed to excellence, and united by a shared vision for a healthier future. We’re ready to help you succeed.
How does Tegria help health plans with Epic Tapestry?
Tegria applies deep experience in Epic Tapestry to help health plans maximize value from system design through implementation and ongoing optimization. Our proven approach draws on years of successful deployments and industry best practices.
How does Tegria help payers implement Epic Payer Platform?
From advisory to project management, we provide full team staffing and project support to keep your Epic Payer Platform implementation on schedule and within budget. With deep experience across provider and payer systems, we help you integrate disparate data sources to enhance collaboration and drive integrated operations.
What does Tegria do to improve payer performance?
Our team brings hands-on operational expertise to every engagement, helping you translate strategy into action with practical payer solutions. We focus on building systems and capabilities that last. Our project accelerators and industry expertise ensure your initiatives are completed efficiently with results that exceed expectations.
How does Tegria help payers with CMS-0057-F compliance?
Tegria supports payer organizations with CMS-0057-F planning, system selection, API readiness, and stakeholder engagement.
Can Tegria help with population health analytics for payers?
Yes. We help payers leverage predictive modeling, real-time analytics, and outcome measurement to proactively manage high-risk cases, monitor UM activities, and drive strategic improvements for enhanced ROI.
Does Tegria work with HealthRules?
Yes, we work with HealthRules. We support payers across all major platforms including TriZetto, HealthEdge, ZeOmega, and Epic, with services that improve efficiency, performance, and scalability.
Is Tegria part of the TriZetto Consulting Partner Network?
Tegria is a preferred partner and active member of the TriZetto Consulting Partner Network (TCPN), working closely with Cognizant (who owns TriZetto) to help payers and providers implement, optimize, and get the most from TriZetto’s core claims and administration systems for improved efficiency and performance.