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.

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
Claims Management

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.

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

 

Download Data Sheet
Read Press Release

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

CMS Interoperability
Claims Management

EDI & Encounters Management

One area of high cost and complexity payer organizations face involves the routing, processing and sharing of healthcare EDI transactions and member information securely between providers, hospitals, medical groups, ACO and other managed care organizations. Zyter EDI & Encounters Management solves the connectivity, security, scalability and interoperability challenges to enable timely processing of these transactions.

Features include:

  • Intake of inbound encounters with L1-L7 validations + custom rules and edits / by state
  • Acceptance and rejection with 999 (partial or full).
  • Enables business process design
  • Enables business process optimization
  • Generate outbound encounter data / file from claims systems or DW/staging ODS
  • End-to-end encounter tracking
  • Hold, fix or discard/regenerate error encounters
  • Match outbound encounter edits to inbound
  • Keep up to states validation edits changes (proactively update)
  • Load response from state (EVR, 999, 277CA, 835, txt reports )
  • Trading partner setup
  • Add custom validations by state
  • Inbuilt data checks for code sets
  • NPI, PECOS, provider taxonomy checks

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