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Blogs & articles

Challenges and Opportunities in the Era of Interoperability

… reduce administrative burdens, and enhance overall care coordination for patients across the healthcare continuum. The CMS interoperability mandate includes: … advancements in healthcare analytics, population health management, and personalized medicine. The interconnected …
Press release

UST HealthProof’s Quality360™ Earns Certified Measures Status from NCQA

… a leader in core administrative services for U.S. healthcare payers, has proudly achieved Certified Measures™ status … highlights UST HealthProof’s dedication to elevating healthcare quality and efficiency, setting a new benchmark for excellence in healthcare management. “We’re proud to receive the benchmark for …
Blogs & articles

Mind the Gap: How to Close Gaps in Care—Fast

… but not in the current year. Timely closure of gaps in care—from health plans to providers and members—is critical to a successful healthcare system.   “The quicker you can close the member gap, … provider network.” – Abe Chaya, Managing Director, Product Management  How to Close Gaps in Care—Fast: Natural Language …
Case study

Navigating Market Hurdles: UST HealthProof Drives Plan to Heightened Quality Ratings and Revenue Growth

… which hinder their ability to provide comprehensive care and support to their members. These limitations can include insufficient funding for innovative healthcare initiatives, limited access to specialized medical … for three consecutive years, the plan showcased robust data management and strategic planning capabilities, resulting in …

Solutions

Insitz Plus

… and performance … In today’s rapidly evolving healthcare landscape, data is the lifeblood of effective … plan leaders must navigate a complex ecosystem of cost management, quality improvement, and equitable care delivery. Insitz Plus is a leading-edge business …

Services

Risk Adjustment

… Trusted technology and services with solutions built for Medicare Advantage and other government healthcare businesses … Strong Risk Adjustment drives success for … and Quality Consulting … Comprehensive Risk Adjustment management that creates value  … Explore our other …

Services

Core Administration

… your plan so you can focus on top line growth, outcomes and care for members … Welcome to our cloud-based payer … that powers our BPaaS ecosystem, our solutions help Medicare Advantage, Medicaid, Commercial, ACA and exchange plans … existing claims administration, Risk Adjustment, member management, and care management solutions … Handle a …

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Home Page

… business, we are singularly focused on unburdening health care. Through our best-in-class, scalable, ecosystem-based … expertise in Risk Adjustment, Quality Improvement and Stars management, we help improve efficiency while lowering your … BPaaS solution is a modern, integrated ecosystem of healthcare operations, processes, and solutions with scalability, …

Solutions

Quality360™ HEDIS Engine

… and data integration. It’s built to support end-to-end management of chart retrieval and data collection, gap … more than others in the market … Identify and prioritize care and quality gaps Attribute gaps to providers Integrated … trends and industry benchmarks, flexible sampling, chase management and integrated medical record review … Integrates …

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Who we help

… and Stars – all developed with the specialized needs of Medicare Advantage, Medicaid, Dual and SNP plans in mind         … in Core Administration, Risk Adjustment, Quality and Care Management solutions         … With a focus on lowering …