Payer Systems + Services

Optimize 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 to improve outcomes while driving down costs.

Advance Your IT Strategy and Systems

Tegria provides comprehensive, client-focused services 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.

They are technology agnostic, but they are experts at what CMS is asking.

The work that we are doing requires somebody very versed with the CMS Medicare program. We need to know how CMS wants us to implement things, how we are going to process claims, how we are going to price the claims, and how we are going to configure all that. The resources from Tegria are experts. They are technology agnostic, but they are experts at what CMS is asking.

CTOJuly 2023, Payer IT Consulting Services,

Advisory Consulting

We provide expert guidance, from strategic advisory consulting to planning services, tailored to the unique needs of health plans.

  • Strategic IT Assessments and Planning
  • Operations and Delivery Transformation
  • Systems Selection
  • Digital Transformation
  • Interoperability

Technology Services

Our team employs multiple approaches to evaluate, understand, design, and implement changes to optimize your operations and systems.

  • Implementation and Optimization
  • Development and Maintenance
  • Program Management
  • Core Claims
  • Care Management
  • 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 Analytics
  • Epic Payer Platform and Tapestry
  • Interoperability Requirements
  • Clinical Data Exchange and Data Integration

Operations + Delivery Transformation

We equip clients with practical, 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.

  • Operating and Delivery Model
  • Agile Enterprise
  • Culture and Leadership
  • Enterprise Lean Agile Transformation

A Proactive Approach to Partnership

  • System Assessment and Selection: We guide payers through system selection, ensuring that technology choices support strategic objectives.
  • System Implementation: Our experience with platforms like Epic Payer Platform and TriZetto ensures a seamless implementation experience.
  • Ongoing Optimization: We continuously refine and enhance payer systems to maximize efficiency and adapt to changing needs.

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
  • NetworX Pricer
  • Payer Platform
  • QNXT
  • Tapestry

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.