Empowering Payer Administration Through Technology

Business Challenges

The payer organizations in healthcare domain are facing significant business challenges such as growing margin pressure, cut-throat competition, and the confluence of providers into the health insurance space. OSP Labs’ payer administration management software solutions delivers trusted enterprise-grade administration and claims management platform solutions to healthcare payers. Our payer administration software solutions are instrumental in enhancing the client satisfaction while minimizing the efforts and cost of operational management in healthcare domain. A vast number of healthcare payers across the world employ OSP Labs’ payer administrative management services to enhance growth, innovation, and efficiencies. We help payer organizations by empowering them with personalized, contextual, regulatory compliant customer communications at comparable rates.

Solution Design & Development

OSP Labs’ payer administrative management software solutions help payer organizations to access crucial information readily, collaborate in-network providers, and incentivize the enhanced healthcare ROI.  

  • Our provider contract management system enables Payers to securely exchange the data both within and outside of the organization. Our payer administrative solutions improve operational efficiencies and offer in-depth visibility into the contract data. OSP Labs' helps to facilitate enterprise-wide collaboration and higher-level accountability with robust provider contract management.
  • OSP Labs' payer administration management solutions empower customer communications to allow payers to access all available data to build prompt, targeted and highly personalized communication across multiple communication channels. It assists payer organizations to boost interaction and qualitative engagement among their members and healthcare providers.
  • Our payer administration software solutions give emphasis on collaborative care management by maintaining the continuity of quality healthcare and smart coordination of care across providers and settings. Driven by quality-based results, our care management solutions focus on refined clinical status, improved quality of life, and enrollee satisfaction, adherence to the offered care plan and cost savings.
Values Delivered
Operational Excellence
Foster transactional efficiencies with payers and providers through smart service delivery models and robust business process frameworks.
Risk Adjustment Analytics
Analyze your risk scores using personalized risk-adjusted model HCCs and take necessary measures to reduce your risk scores.
Payment Accuracy
Gain access to integrated and end-to-end payment solutions and drive down costs through accurate, faster and better payment channels.
Compliance Management
Compliance Management
Secure the access to PHI, gain assured HIPAA Compliance, and achieve real-time reports on document changes with robust compliance management.
Claims Adjudication
Claims Adjudication
Implement real-time claims adjudication to assess, plan and implement system improvements to reduce the turnaround time.

What Makes OSP Labs’ Payer Administration Solution Best for Your Need?

OSP Labs' payer administration software solutions work by solemnly focusing on the payer organizations core needs. We connect diverse business ecosystems and build trust with standalone healthcare payer administration management solutions.

Reduce the time and cost of performing critical healthcare business functions by automating the payer administration processes.
Manage, control and share the crucial healthcare data with providers and payers alike to address the need for regulatory compliance.
Improve response time, streamline appeals & grievances and efficiently manage business operations with robust case management tools.
Enhance the productivity and quality of existing healthcare services and improve the usefulness of current applications that benefit payers.
Streamline the health insurance registration process to minimize compliance risks, increase accuracy & speed and boost providers proficiency.
Monitor and allocate the resources efficiently to counter the operational challenges faced by the Payers and gain best possible ROI.
Provide prompt, personalized and effective healthcare services by facilitating member engagement, involving patients in their care plans.
Facilitate seamless communication and collaboration among providers and payers to offer prompt and personalized healthcare solutions.

Healthcare Payer Administration Software Services


Digitize Insurance Registration Process 

  • Leverage the benefits of automation technology to digitize the insurance registration process
  • Streamline the registration workflows
  • Minimizing compliance risks and enhancing the accuracy of data
  • Improve speed of processes and provider’s proficiency
  • Reduce the cost of critical health business operations

Develop Seamless Communication Payer-Provider

  • Ensure prompt and personalized communication between payers and providers
  • Securely exchange data across the providers’ network and internally
  • Boost qualitative engagement of payer members and healthcare providers
  • Effectively manage the response time, appeals, and grievances 
  • Improve collaborative care by offering personalized health solutions

Optimize Claims Adjudication and Management

  • Automate claims processes to minimize time and errors
  • Deploy real-time claims adjudication to assess and implement system improvements 
  • Ensure accuracy in claims adjudication with real-time analytics 
  • Identify suspicious claims to minimize fraud and revenue loss
  • Assessment of claims according to health plans offered by providers

Solutions We Offer

Frequently Asked Questions

The Health payer’s role in the care ecosystem is to balance the cost and quality of care. Their primary job is to manage the resources of patients’ care plans to ensure the best care outcomes at the least expense. Payer care management, thus, focuses on aligning cost with care outcomes. Payer care management solutions offer analytics and streamlined workflows to help healthcare payers efficiently manage and improve the care conditions of patients/members. 

Payer provider analytics or just healthcare payer analytics software are solutions that monitor and do profiling of provider practice patterns. The software also assesses bundled payments and oversees risk-based arrangements. With payer-provider analytics data software, healthcare payer organizations can partner with providers that align with their cost and quality policies to ensure quality care. 

Payer quality analytics, primarily a part of payer analytics software, are solutions used by payers to measure the performance on quality of care. Quality analytics, along with risk adjustment technology, is mostly used by payers to structure claims and clinical information into effective, actionable models, identify risk indicators, and foster provider collaboration. 

A payer technology company offering a healthcare payer solution usually caters to various payers from health plans, insurance companies, government, and specialty groups—the health payer solution help in addressing strategic priorities and navigating trends in healthcare. Payer solutions oversee information sharing for enhanced care coordination, amplify provider network management, and leverages risk analysis. It can analyze and automate value-based care models to simplify and scale complex payment processes. These solutions also manage care costs in collaboration with providers to ensure improved patient outcomes at a minimum expense.

Healthcare payer administration software is the solution that caters to payer companies by improving their administration and claims-related workflows. These solutions are instrumental in reducing operational management costs and working collaboratively with healthcare providers to offer personalized and affordable care. The healthcare payer administration software also manages providers’ contracts and customer communication. Moreover, the software even offers risk adjustment measures and claims adjudication to speed up payment processing.   

Home care software for payers is the digital solution for health plan companies or insurance companies that specifically caters to home care providers; to manage and coordinate the care delivery at patients’ homes. This payer software is typically used for services like skilled nursing, home health, and more. The software manages patient care plans, monitors outcomes, and communicates with care providers to ensure timely care delivery.

The payer administration software must include essential features like automated workflows, claims processing and management, automatic eligibility verification, providers’ network management, collaborative care management, analytics, reporting, and compliance. These essential features can oversee all processes, minimize errors and reduce the turnaround time to generate better ROI. 

Core Administrative Processing Solutions or CAPS serve as a crucial tool for the U.S. healthcare payers such as insurance companies, government, or health planners. These tools are instrumental to business enablement, primarily software and services catering to insurance administration and transaction processes. These core administrative processing solutions are often used to record claims, member enrollment, premium billing, and care providers’ fee schedules. CAPS is a significant tech investment for payer companies, even though these are tough to maintain.   

Healthcare payer care management has multiple roadblocks, including criteria to meet operational efficiency, regulatory requirements, and delivering high-value demands of consumers. A core administrative processing system, or CAPS, is the best-suited tool to mitigate these roadblocks. This solution ensures high efficiency in operations, seamless interoperability, and agility in workflows. 

Healthcare costs are typically covered by two types of payers- private and public. Private payers are mostly insurance companies, while public payers are state or federal. Private payers offer different plans that must meet the standards set by the government. Further, payers can be categorized as health planners, payers, insurers, and providers.   

Case Studies

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

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Healthcare Analytics Solutions: An Integral Part of the Medical Industry

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See how our solutions can help resolve your healthcare challenges.