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Healthcare Payers

Improve data quality, manage social risk factors
and find other insurance coverage through enhanced
data to boost your bottom line

The health of your data has a major impact on your bottom line.

TransUnion Healthcare offers revenue protection and data integrity solutions to healthcare payers, including:

Other Health Insurance (OHI) Discovery

Identify potential first-in-line insurance coverage for your member claims. Our OHI Discovery solution — offered to payers and cost containment vendors — leverages TransUnion’s proprietary data assets to discover previously unknown coverage. Findings are verified as active for the date of service ensuring only viable, high-quality results are returned. As a result, you can recover payments for incorrectly paid claims and improve your coordination of benefits process.

Learn about Other Health Insurance

Encounters and Claims Management

Improve the quality and timeliness of encounter data received by healthcare providers and reported to regulatory agencies. Our Encounters and Claims Management solution ensures data integrity by validating and applying edits to inbound encounter and claims data in advance of reaching your IT system. Our expert data team works to ensure providers correct rejections using our industry-leading web portal, and TransUnion Healthcare’s proprietary reporting and analytics gives your organization complete insight into the status of submitted and rejected transactions.

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Clinical Data Clearinghouse

Find missing clinical data to improve clinical outcomes and increase provider connectivity. TransUnion Healthcare’s Clinical Data Clearinghouse solution —through our extensive network of data connections — transmits hard-to-format clinical and supplemental administrative data from laboratories, physician offices and various clinical databases. This data is delivered in an easy-to-digest format making it immediately actionable.

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Predictive Data for Social Determinants of Health

Identify and address social factors that impact health to make smarter population health management decisions. TransUnion Healthcare’s Social Determinants of Health solution —available to payers and cost containment vendors — delivers the industry’s most powerful and relevant datasets to help identify members most at risk of over or underutilizing healthcare services. When combined with claims and clinical data, these datasets have useful applications for risk stratification, predictive modeling and care management — leading to better health outcomes and lower costs.

Learn more about Predictive Data for Social Determinants of Health

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Member Identity Management

Engage members and effectively coordinate care by updating outdated or missing contact information. Our data-driven Member Identity Management solution helps ensure accurate member information. Our databases contain information on over 95% of the U.S. population including over 13 billion unique name and address combinations and 4 billion telephone records, to ensure you have optimal contact information to reach your members.

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EDI Solutions

Stay compliant with a HIPAA-compliant EDI process to interact with providers and regulatory agencies. Our EDI solutions support all types of healthcare transactions, including encounters and claims (837P, 837I, custom formats), insurance eligibility (270/271), acknowledgments (999/277U), claim status inquiries (276/277), ERA (835), healthcare provider information (274) and prior authorization (278).

Learn more about EDI Solutions

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