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Next-Generation, Intelligent Master Data Management Empowers Health Plans & Payers

For 30+ years, our partner, IMT has helped manage health data throughout the healthcare ecosystem, working with providers and payers alike to deliver complete, 360-degree views of patients and members. 

Now, IMT has invested its learning to deliver IMT Health:iDM for Health Plans & Payers built on the Semarchy unified data platform. Optimized for health plan domains, relationships, and workflows, Health:iDM helps payers streamline their data exchange, internal processing, and analytics with a multi-vector hybrid architecture that supports both transactional and analytics data in the same platform.

How intelligent data management empowers Health Plans & Payers 

More intelligent data management helps health plans and payers tackle their biggest challenges. Health:iDM gives you a single, trusted view of members and providers, plus all the relationships and hierarchies among them. With that trusted view, you can:

  • Streamline claims operations by automatically matching relevant data. This reduces the need for manual claims processing, speeding up resolution times while reducing errors.
  • Identify duplication, overpayments, fraud, or abuse by understanding the linkages between members, providers, and claims. 
  • Understand provider hierarchies, credentials, and network status. According to an IDC report, an estimated 20 to 30% of physicians change their affiliations in a given year, while another 5% change their status (lose their license, pass away, or receive sanctions). Health:iDM helps you stay on top of these changes by delivering the most current, accurate data to the systems where it’s needed.
  • Enable real-time and predictive analytics, building on trusted, high-quality data. Leverage this data to support automated workflows, decision-making, and cost forecasting, plus performance scorecards and bundled payments.

How we optimized Health:iDM for Health Plans & Payers 

IMT started with Health:iDM, which is built on Semarchy’s unified data platform. Then we optimized the platform for how payers operate, creating a golden view of relevant data (members, households, dependents, providers, and claims) that can be shared with enterprise analytics and other stakeholders.

Health:iDM’s agile and flexible platform enables you to define and execute intelligent cross-departmental workflows that can identify potential data issues before they impact downstream systems, helping prevent duplicate claims and the costs associated with remediation.

Data profiling, integration and analytics on data quality and composition streamline code list management and validation for procedures, diagnosis, and conditions. We wove in an enterprise business glossary and data dictionary that reflects the data elements typically shared across claims processing.

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Whether your data governance policies dictate centralized ownership, distributed collaboration, or a hybrid, the right workflows can be rapidly defined for unique stakeholder needs. Develop apps for data retrieval and review, authorship, or exceptions management – there are no boundaries on the quantity and focus of the data apps you can build and distribute to data consumers.

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Finally, we know that regulatory compliance is evolving. The No Surprises Act, anti-information blocking and access mandates for patient and provider data, and other rules to come, require an agile approach that allows you to easily capture new data elements or share data with new places. With our flexible platform, you can do exactly that as your needs change.