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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.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Medical Claims Management

Leading the transformation of traditional claim processing with electronic claim solution with an automated EDI workflow that improve provider-to-payment process, reduces follow ups, and decreases management cost.

We leverage HIPAA-mandated data translation and formats for secure connectivity between payer-to-provider system so that every claim is processed accurately.

With state-of-the-art technology, we enable your organization to capture data transaction and claim forms for electronic processing.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Collaborative Care Management

Empowering healthcare payer software solutions that emphasizes on continuity of care across provider networks.

Driven by technology, collaborative care management for payers focuses on provider-led health programs to improve quality of life, clinical status, and patient satisfaction.

We deliver leading-edge software solution to control patient health by providing on-demand health support, real time care delivery through mhealth and wearable technology, and integrated application for multitude of services necessary to improve overall health of the patient.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Provider Network Management

Simplifying the complex contract management between providers and patients.

Our network management solutions help healthcare payers streamline the design, servicing and management of provider network whilst offering the flexibility to employ new collaboration and network strategies with healthcare providers and enhance care delivery and payment approaches.

We work dedicatedly with payers to improve complex interactions between providers, simplify credentialing, contracts, and reimbursements.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Payer Administration

We deliver industry-leading business administration solution tailor-made for payers of different size.

Our core administration software solutions are designed to help you automate business processes, streamline workflows, and increase efficiency and productivity.

With integrated administration solution, you can optimize claims management process, automate membership, improve user-defined care, proactively manage regulatory compliance, and support EDI driven with HIPAA while delivery patient satisfaction.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Fraud, Waste & Abuse Management

We deal with payers of all size to create solutions that detects, corrects, and prevents claim fraud, waste and abuse.

Leveraging the power of technology, we build best-of-breed solution that improves payment integrity and accelerates claim adjudication. From complex data analyze to claim error report, our solutions are designed to increase your business efficiency while maintaining regulatory compliance.

We build software solution for payers with a goal to reduce claim errors, meet cost containment objectives, detect claim fraud before payment, and streamline investigations.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Payer Cost Containment

We partner with growing healthcare payers to help them successfully control expenses.

We boost your business goals with personalized tools, platforms, and software that empowers your care management program, business management, and provider networking while dramatically reducing costs.

Our software solution for cost containment organizations includes automated medical billing review, medication analysis, specialty contract management, quality and cost-effective care delivery.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Risk Adjustment/Adjudication

OSP Labs delivers an integrated software solution custom-built for all levels of claims management for payers to succeed in revenue-critical risk adjustment business.

From suspect targeting and prospective health assessments to medical coding retrieval and record coding, our software development solutions offer an accurate view of your risk conditions-undocumented and unreported claim conditions.

We offer full-service risk management software services to eliminate claim-based errors, drive productivity, and increase your business ROI.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Data Mining

Our aim is to transform traditional data warehouse to more structured cloud-driven data models for healthcare payers across service domain.

Leveraging the power of technology and big data, we are building tools, platforms, and software that enables payers to secure, integrate and examine large sets of information driven from varied healthcare sources.

Our best-in-class big data team collaborates with healthcare experts to build result-oriented advanced data analysis tools to improve clinical efficiency, health outcomes, and overall elimination of claims fraud.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Case Management

OSP Labs strives to empower the healthcare payer organizations with custom medical case management software solutions to effectively manage multiple cases, make qualitative decisions and handle high-value exceptions.

Our medical case management software solutions offer functionality and integration of data to manage the highly complex healthcare issues. Leveraging the power of the cloud and advanced technology, we simplify the case administration and reporting ability to offer a comprehensive overview of your organization’s activities.

We dedicatedly work with healthcare payers to enhance healthcare payer solutions process and make smart decisions for better outcomes.

Payer Solutions | healthcare payer solutions | healthcare payer solutions software

Clinical Decision Support

We offer personalized resources to improve the clinical decision making capability by delivering analyzed information, tools, and processes to payer organizations.

OSP Labs tailors clinical decision support system to empower payer organizations with vital information and optimized processes that guide intelligent care decisions and reduce complexity from the fundamental healthcare operations.

From semantic interoperability and innovative knowledge management tools to multi-parameter alerting, our custom clinical decision support system offers a real-time, patient-centric and premium-grade quality of care.  

From complex-to-simple, some of our solution-driven health projects.
Payer Solutions | healthcare payer solutions
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.
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.
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.

Keeping the Trust

We follow every government regulatory mandate and creates solution that follow strict protocols.

Contact Us

Let us address your healthcare challenges with our solutions.

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