Innovative Healthcare Payer Solutions for a Digital Future

Managing the demands of members, providers & regulators

Innovative <span>Healthcare Payer</span> Solutions for a Digital Future

The Industry

As members, regulators, and health systems make growing demands on payers, they often find themselves short on key resources and systems. Health plans need to carefully collect and store terabytes of precious data on millions of members and providers – at a time when demands for access and the threat of cyberattacks are often competing. Health plans also tend to absorb the blame for troubles that originate elsewhere – and relevant solutions are seemingly hard to come by.

Provider data is a crucial component of healthcare system success – as well as a constant burden for health plans to maintain. PRIME® — a platform from Atlas Systems — solves the provider lifecycle challenge with a rigorous, proven approach that incorporates provider data validation, ongoing monitoring, provider training, and more to drive compliance and improved member satisfaction.

Problems Atlas solves

Provider data accuracy

Atlas takes a gold-standard approach to provider data validation, achieving best-in-class data accuracy with 95% client-audited quality assurance and up to 90% validation success.

Member complaints & regulatory compliance

Accurate provider data makes sure that members get connected to the right doctors – and keeps regulators at bay

CMS’s Appointment Wait Time requirements

Qualified Health Plans (QHPs) will need to measure and report appointment wait times, using an independent third- party, for various products and markets beginning January 2025. Turn to Atlas for help.

Provider Directory Compliance

Atlas delivers & fulfills instant, high-quality, ADA-compliant versions of your directory on paper or in PDF

Ongoing Monitoring

Leveraging the Limited Access Death Master File and other key resources, PRIME helps you keep your listings accurate and complete, with no hassles or worries

Provider Training

We deliver state-of-the-art technology to provide a positive, structured, and fully customizable training experience that ensures that providers in your network are fully trained for delivering quality care.

Success story

Key New York health plan relies on PRIME to manage provider data quality
A leading New York-based provider of primary and specialty care and wellness solutions to millions of people in the New York area needed help managing its health provider directory. Atlas PRIME delivered a combination of technological innovation and strategically grounded expertise, as well as highly trained staff to conduct direct provider outreach. The result: Verified provider data with completeness, timeliness, and quality.

Atlas client speaks

“PRIME scored 100% on a recent quality audit of our provider data accuracy. We’ve been impressed by their quality scores and dedication to providing the most accurate provider data possible. PRIME has increased our provider directory accuracy and enhanced member experience.”

Operational leader

Northeastern health plan

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FAQs About Healthcare Payer Solutions

What healthcare payer software solutions does Atlas Systems offer?

Atlas Systems gives you a range of healthcare payer solutions, including provider data management, third-party risk monitoring, claims workflow automation, and regulatory compliance tracking. These tools help you manage your payer network more efficiently and meet performance benchmarks.

How does Atlas Systems assist healthcare payers with compliance and regulatory requirements?

You can use Atlas Systems to monitor provider credentials, conduct real-time audits, and automate reporting for CMS, HIPAA, and other regulatory standards. The platform helps reduce risk and supports accurate documentation.

Can Atlas Systems integrate its payer solutions with existing healthcare systems?

Yes. Atlas Systems' solutions connect with your current EHRs, claims systems, and data platforms using secure APIs and batch uploads, so you can work with real-time information without restructuring your environment.

What role does AI and automation play in healthcare payer solutions?

AI and automation help you reduce manual tasks like credentialing reviews, claims validation, and provider directory updates. These tools allow your team to act faster and focus on higher-value priorities.

How can payers leverage Atlas Systems to reduce administrative costs?

You can cut costs by automating repetitive tasks, minimizing claim rework, and improving provider data accuracy. These efficiencies help lower overhead while improving member and provider satisfaction.

How can Atlas Systems help healthcare payers transition to digital-first operations?

Atlas Systems offers cloud-based platforms, self-service portals, and real-time dashboards that make it easier for your teams to manage tasks online, reduce reliance on paper-based processes, and operate more effectively.

How can healthcare payers get started with Atlas Systems’ solutions?

You can contact the Atlas Systems team to schedule a strategy session. They’ll review your operational goals and show you how to launch the right solutions for your payer network.