Healthcare Payer Solutions

Navigate the complexity of value-based care with TransUnion payer solutions

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The industry is quickly moving from fee-for-service to value-based or managed care payment models. By 2018, HHS has declared that 50% of payments must be value-based. Now is the time to evaluate your data submission incentives and required analytics to ensure you’re prepared to make the shift to value-based payment models.

TransUnion Healthcare Payer Solutions leverage more than 25 years of experience in managing the “capitated” or managed care data required for these new payment models. Additionally, as a national EDI clearinghouse, TransUnion delivers:

  • One platform for processing encounters and claims data
  • Clinical outcome data from your providers groups delivered to your “doorstep” in an actionable format
  • A full suite of HIPAA-compliant EDI solutions (270/271, 274, 276/277, 278, 835, 837P, 837I, 977/277U)
  • Health plan membership file hosting
  • Provider file management (EDI 274 processing)
  • Other health insurance discovery to identify potential first-in-line coverage for your medical claims
  • A low cost solution—more cost-effective than performing it internally

Be prepared for value-based care with a suite of payer solutions from TransUnion

  • Encounters and Claims Management: Capture maximum encounter data with the ClearIQ submitter platform, which includes features designed specifically for value-based payment models, including submitter mass-error correction, auto archiving and transparent payer reporting
  • Clinical Data: Get clinical and supplemental administrative data from your provider groups delivered to your “doorstep” in an actionable format
  • EDI Solutions: Stay compliant with HIPAA regulations by using a standard EDI process to interact with providers
  • Hosted Membership: Automate your provider interactions with membership file hosting, EDI services and customer service for a nominal monthly fee
  • Provider File Management: Take the EDI 274 burden off your hands by letting TransUnion manage the conversion and submission of your monthly Medi-Cal provider roster files for you
  • Other Health Insurance Discovery: Maximize your reimbursement sources by identifying alternative insurance coverage for your medical claims
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