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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:

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Social Determinant Risk Attributes

Identify and address social risk factors that impact members to enable smarter population health management decisions. TransUnion Healthcare’s Social Determinant Risk Attributes deliver powerful datasets to help address:

  • Risk classification
  • Prognostic modeling
  • Care management
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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
  • Include only viable, high-quality results
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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
  • Providers correct rejections
  • 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 transmits hard-to-format clinical and supplemental administrative data in an easy-to-digest format from:

  • Laboratories
  • Physician offices
  • Various clinical databases
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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Engage members and effectively coordinate care by updating outdated or missing contact information.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
  • 4 billion telephone records
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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:

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