HEALTHCARE

Payer Solutions

From providing clinical support for care management to driving claims management efficiencies, Zyter has got you covered. Learn
more about our solutions that help streamline operations and improve the patient/consumer experience.

Member Engagement

Zyter Member Engagement is a secure, patient-facing portal and mobile application that increases engagement. As a result, payers can deliver a personalized digital experience that spans patient registration, current benefits, messaging, payment gateway integration and more. By providing improved data access, members can efficiently and effectively manage their health and all payer interactions.
Features include:

    • Easy claims, authorization and explanation of benefits look up
    • Chatbot integration with secure messaging
    • Comprehensive billing and payments functionality
    • Medical card printing and mailing

Zyter Payer Solutions are ideal for Commercial Payers and Self-Insured Employers.

member engagement
 Zyter’s CMS Interoperability solution can help you meet all requirements with ease

CMS Interoperability

The Interoperability and Patient Access final rule (CMS-9115-F) gives patients direct, secure access to their medical records anywhere and anytime. January 1, 2021 is the first of a series of compliance deadlines – and healthcare organizations and payers not in compliance with an interoperability solution will face penalties and hefty fines. Zyter’s CMS Interoperability solution can help you meet all requirements with ease.

Features include:

  • Out-of-the-box connectivity to leading EHR, payer and provider systems
  • Complete FHIR® solution with FHIR repository
  • FHIR® 4.x support
  • Over 1,300 formats and data elements mapped to FHIR
  • Provider and payer data integration

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Zyter Payer Solutions are ideal for Commercial Payers and Self-Insured Employers.

Care Management

Zyter provides care management teams with a complete, 360° view of every patient across the health care system. Zyter also supports early intervention through improved clinical monitoring, providing your care managers with detailed health insights for increased efficiencies.

Features include:

  • Reduce variations in care, increasing quality and alignment with best practice
  • Customize patient education services to improve care plan and medication adherence
  • Streamline healthcare transactions for everyone across the care continuum

Zyter Payer Solutions are ideal for Commercial Payers and Self-Insured Employers.

care management
Enrollment Manager

Enrollment Manager

Zyter Enrollment Manager streamlines and automates the enrollment lifecycle, resulting in faster eligibility verification, an improved patient experience and better health outcomes. A real-time verification process available through a single portal streamlines communication with payers. In addition, healthcare providers can utilize highly efficient workflow to communicate with all types of insurance payers resulting in insurance verification coverage in mere seconds, not hours or days.

Features include:

  • Easy integration with all payer membership systems and scalable to accommodate multiple trading partners
  • Supports both real-time and batch processing with always-on architecture
  • Business workflow UI to pre-scrub and validate prior to loading into membership system
  • Ability to fix errors on each file and resubmit with configurable validation
  • Ability to fix errors on each file and resubmit with configurable validation
  • Automated membership updates with support for multiple companion guides

Zyter Payer Solutions are ideal for Commercial Payers and Self-Insured Employers.

Claims Management

Both payers and providers are trying to digitize the submission of claims, mine the databases that maintain patient data and comply with regulatory and industry standards like HIPAA. Zyter brings clarity to complexity with a suite of claims management solutions to help boost operational efficiency.

Features include:

  • HIPAA compliant microservices-based healthcare platform to process healthcare industry standards EDI, HL7 and SMART on FHIR Integrations and non-EDI transactions
  • Integrate easily with major payer systems such as, QNXT, HealthEdge, and legacy mainframe systems
  • A real-time verification process available through a single portal streamlines communication with payers
  • Single source submission, editing and reconciliation of claims including Medicare claims verification

Zyter Payer Solutions are ideal for Commercial Payers and Self-Insured Employers.

Claims Management
Encounter Manager

Encounter Manager

Zyter Encounter Manager simplifies the complexity of encounters processing by providing payers with end-to-end tracking and visibility to minimize rejections and discrepancies. Zyter’s fully automated solution helps health plans prepare, validate, securely submit, and in rare cases, correct and resubmit encounter data to states. As a result, health plans can achieve higher acceptance rates and capture more reimbursement while avoiding fines for late, inaccurate or incomplete data submissions.

Features include:

  • Microservices-based solution for third-party integrations, platforms, products
  • Customizable dashboard UI for reporting and metrics
  • Send validated encounters to states with unique edits
  • Keep up with state validation edits/changes (proactively updated)
  • Post processing logic to filter error encounters

Zyter Payer Solutions are ideal for Commercial Payers and Self-Insured Employers.

EDI Manager

By processing thousands of transactions in parallel and allowing multiple provider systems to query payer systems for status checks and patient information, Zyter EDI Manager delivers the highest levels of processing automation to streamline workflows and increase efficiency. 

Features include:

  • Processes healthcare industry standards EDI, HL7 and SMART on FHIR Integrations and non-EDI transactions
  • API-based architecture supports CDS Hooks implementation that facilitate connectivity between provider’s EHR/EMR systems and payer systems
  • Containerized architecture simplifies implementation and supporting IT infrastructure
  • Secure data exchange using 256-bit AES encryption

Zyter Payer Solutions are ideal for Commercial Payers and Self-Insured Employers.

EDI Manager