Healthcare Provider Software Solutions Company

Healthcare Payer Solutions

Segments We Serve

Our mission is to improve every gamut of healthcare payer business.


Health Plans

Flexible value-based solution for health plans and payers for diverse healthcare specialties.


Managed Care

Managing provider-payer collaboration solution such as HMO, PPO, ACO, EPO, IPA, PFFS, and POS.



Made for government-sponsored payers: Medicaid, Medicare, VHA, PACE, CHS & community program.



Delivering claim processing and business intelligent solution for self-funded and fully insured TPAs.


Specialty Payers

For healthcare organization involved in dental, vision, behavioral health, oncology and other specialties.


BlueCross and BlueShield

Tailor-made competitive solution and services for enterprise payer: BlueCross & BlueShield.

Solutions We Offer

We help payers deliver a well-coordinated, cohesive and affordable healthcare experience.


From complex-to-simple, some of our solution-driven health projects.

Transacting Information Across Health System

The need of the hour was a seamless system that allows millions of health data exchange between multiple health systems.

  • We built a master framework to allow two or more system interact and share patient data secured with PHI, HL7 & HIPAA guidelines to drive better patient outcomes for providers and patients globally.
  • Development of health information exchange (HIX) web and mobile portal that streamline and maintain data flow between payers and providers.
  • Our customized web portal software solution proves to be a one-stop marketplace for individuals to compare plans, get provider network information and apply for the right coverage.
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Payer Solutions | healthcare payer solutions

healthcare payer software solutions | Payer IT Solutions

Simplifying Billing Hurdle For Mental Health Centers

The challenge was to bring different individuals involved in claim management process from a community center, physicians, medical coder, and biller to payer and government under the same roof.

  • A complete web-based claim management software solution was tailor-made for clinics who wanted to reorganize the claim process workflow from physician to government payers.
  • With granular-level user roles and reimbursement control, the feature-packed platform offers maximum confidential data security controlled by HIPAA rules.
  • Using CPT codes, psychologists can quickly file a claim that reduces denial ratio from billing reviewer and getting reimbursed on the same working day.
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How We Do It?

Applying principles and innovation to create game-changing solutions.

Insight-Driven Business

At OSP Labs, we’re helping clients achieve their goals using an analytic-led approach to deliver a truly insight-driven solution every day. With our healthcare payer solutions , we help you harness digital capabilities, embed analytic decision-making, and adopt rapid technology disruption to drive business value with forward-looking insights.

Agile Development Network

Scalable software solutions made with integrated agile processes for effective business outcomes. Healthcare Payer Solutions are made with customizable agility to meet health-specific standards. We bring teams together who collaborate across multiple engineering environment, indifferent of tools, compliance, and methodologies.

Complete Compliance Support

With dramatic changes in regulatory complexity, our specialists offer compliance consulting to address and repair your health organization effectively. OSP Labs health care compliance and risk support help you not only understand the risks but also identify opportunities to strengthen your organization.

we work with the best

Healthcare Payer Solutions Services 


Claims Management

  • Leverage automation in EDI workflows to boost provider payment process
  • Offering automation technology in claims processing to reduce errors and costs
  • Efficient capture of data transactions and claims forms digitally
  • Adherence to HIPAA standards for data translation and ensuring full security of claims data 
  • Increase overall efficiency and decrease follow-ups on claims

Cost Containment Optimization

  • Offer expense control tools to growing businesses of payers in the healthcare
  • Leverage specific digital tools for payer care management program
  • Deploy personalized tools to boost payers' business and improve their provider networking
  • Facilitates automation in reviewing bills, medication analysis, and specialty contract management
  • Optimizes solutions to cater to the cost-effective delivery of care

Risk Management and Adjudication 

  • Customized solutions to help payers manage claims at all levels
  • Accuracy in risk assessment in different operations 
  • A complete view of risks and conditions of undocumented and unreported claims
  • Optimizes claims processes by mitigating human errors and missing information
  • Improve productivity and boost ROI 

Frequently Asked Questions

Organizations that determine service prices collect payments, handle claims, and pay provider claims are known as payers in the healthcare sector. Examples of payers include Medicare, Medicaid, and health plan providers. Often, payers and providers are distinct entities. Hospitals or clinics are examples of providers. A payer and a provider, however, in some circumstances, be the same organization. Take, for example, Veterans Affairs, which allows patients to obtain care at the institution while having their costs reimbursed by the facility (or being referred to other specialists).  

Healthcare payers also have a chance and a reason to get involved in redesigning how care will be delivered. Payers in healthcare have complete visibility into patient care needs and usage trends across providers and settings, in contrast to many other stakeholders. This viewpoint can guide decisions regarding the best care models, unleash the value of care through enhanced health outcomes, and reduce the overall cost of care for members and patients. In addition, payers can rethink their business models to focus on assisting people in maintaining their health and receiving the appropriate care at the appropriate time.

Healthcare payers may generate significant value for the health plan, members, and customers by expanding their role in care delivery. While the specific opportunities differ depending on the market and the strategy employed, several value levers are common to all of them. Firstly, it improves the member experience. Industry leaders in innovation are establishing consumer expectations in healthcare, and the emphasis is on personalization, omnichannel access, digital enablement, and continuous and seamless service. Moreover, payers and providers are now being evaluated and paid based on the experience they provide to members. Besides, evidence reveals that innovative managed care models leverage a higher number of screenings, tests, and vaccines, ultimately indicating health and wellness. So, it also improves health outcomes.   

Payers commonly designate priority regions for their programming efforts in care delivery based on populations or conditions. For instance, medical payers might create care models for patients with numerous chronic diseases and complex requirements, housebound or end-of-life care, depending on the degree of care needed. In contrast, payers might concentrate on care models for particular conditions like oncology, cardiology, musculoskeletal, women’s health, or neurology. Another approach can be focused on specific engagement and delivery strategies, such as virtual first care or home-based care.

The payer’s primary responsibility is to balance cost and care quality. Their routine involves allocating resources to a patient’s treatment plan to obtain the best result with the least amount of money invested and wasted. Healthcare payer services focus on and involve a particular patient population to help align costs with treatment results for their members. Programs like complex case management, management of chronic conditions, and programs for healthy living and prevention are a few examples of these initiatives.  

Today, payer providers’ forecasting is shifting towards real-time data analytics because it helps them create resilience in their business. Real-time data analytics requires healthcare payers to pursue interoperability and move over the traditional approach mindset. Real-time analytics can help payers to anticipate the shifts in memberships. With the market downturns, ns, payers in healthcare can see an increased churn between employer health plans, ACA providers, Medicaid and Medicare. Payers can leverage real-time data to predict and evaluate the implications of these churns. It also helps payers understand how demands are changing and enable them to create the right opportunities and capabilities. 

Several tools for enhancing healthcare quality and delivery are included in the healthcare payer software systems. These resources include systems for population analytics, outcome measurement, and enhanced reimbursement plans. To guarantee that payers and payer insurers submit the best claims for covered services, healthcare providers must keep an eye on the healthcare claims ecosystem. It must ensure that the analytics tools, which give the information required for payer organizations to make informed decisions, must also assess their usefulness and accuracy. Healthcare professionals should also consider how any automated, effective technology may affect their capacity to deliver high-quality healthcare.

Any payer-driven initiatives to interact with selected members and their care ecosystems to promote and facilitate high-value decisions regarding their care and enhance self-management are referred to as payer care management. Payer care management aims to assist payers in responding to members’ concerns about traveling to common care facilities and the increasing pressure on their overall health.

Increasing healthcare costs pressure healthcare payers to produce high-value results for their members. So, payers are leveraging outcome-based analytics in their healthcare payer software to streamline operations and improve efficiency. The outcome-based analytics help payers in healthcare to be better at decision-making by helping them improve benefits planning, identifying emerging trends, assessing providers and treatments, and measuring the effectiveness of care management. Besides, payers can improve payer/provider interactions and give customers accurate, timely guidance by developing and exchanging analytical insights. Moreover, outcome-based analytics helps payers manage costs and increase revenue. At every level of the health claims reimbursement process, more data transparency and visibility aid healthcare payers in identifying and preventing fraud, waste, errors, and abuse.  

Some examples of healthcare payer software are Payer Care Management Solutions, CMS Payer Interoperability Solutions, Claims and Administration Platforms for Payers, CRM for Payers, Payer Quality Analytics Solutions, and Risk Adjustment Solutions for Payers. 

Latest Talks


How Healthcare Payer Platform Plays a Crucial Role in Improving the ROI for Payer Companies?

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Healthcare Payer Automation: Definitive Playbook for 2023

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Healthcare Payer Analytics: Making The Health Data Imperative To Boost ROI

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Build vs. Buy: How to Know When You Should Build Custom Healthcare Payers Solutions Software

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How the ICD-10 Transition will Improve Healthcare Efficiency for Provider, Payers & Billing Companies

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Healthcare Analytics Solutions: An Integral Part of the Medical Industry

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Let’s Talk

See how our solutions can help resolve your healthcare challenges.