Connecting
Payers and Providers
Mergence Health is connecting Payers and Providers to simplify the administrative complexity between care delivery and member management providing exceptional healthcare experiences for all
Impacting Providers and Payers
It is estimated that about 25%, or $760 billion to $935 billion of expense, is potentially wasteful spend. Of that spend about 30% is attributed to administrative costs. Our services are designed to transform the healthcare experience and reduce unnecessary administrative spend through better connections and simplifying technology. The result is faster, more accurate, and more personalized care for patients, ultimately leading to healthier communities.
[1] Reducing Administrative Waste in the US Health Care System https://jamanetwork.com/journals/jama/article-abstract/2775721
Simplifying Complex Integrations
Mergence Health Platform for Payers:
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Integrates administrative and clinical data into payer systems leveraging networks such as Epic Payer Platform
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Provides the relevant clinical data at the right time into existing workflows
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Enables context aware payer insights delivered into the provider EHR
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Eliminates provider abrasion and reduces operating expenses through artificial intelligence
Supported Use Cases
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Prior Authorization including CMS-0057-F
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Claims Attachments including CMS-0053-P
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Risk Adjustment Record Retrieval and Care Gap Closure
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Clinical Data Exchange for HEDIS and Quality