Payer & Insurance Providers

Payers and Health Plans require collaborative partnerships with providers in order to gain real time visibility into patient information and deliver high-quality, cost-effective care.

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Iguana creates a better synergy with healthcare payer and provider systems to optimize cost management and focus on delivering outcomes.

The insurance provider space is riddled with legacy systems, creating barriers when trying to develop interoperability pathways to other platforms and external solutions. As a result, quick and efficient capital and risk matching is hindered.

However, with the right tools and technology, successful digital transformations for healthcare payers and insurance providers can be achieved. With Iguana’s robust integration solution, payers and providers can support real-time, bi-directional data exchanges handling a large variety of data standards including X12 EDI, HL7, FHIR and C-CDA. By facilitating start-to-end integration, insurance organizations are able to reduce differences between processes and data aggregation.

Benefits for Payer & Insurance Providers

Expedite claims processing and reduce costs

Iguana can process tens of millions of messages a day, and supports connectivity to virtually any healthcare-based platform. Our patented development environment enables you to easily create the expedited data pathways required for analytics-driven approaches to claims handling while simultaneously minimizing your total cost of system ownership and meeting Centers for Medicare and Medicaid (CMS) mandates.

Validate patients eligibility in real-time

Eligibility validation is the first and most important step in the claims and revenue cycle process. Iguana provides built-in, real-time X12 EDI 270-271 eligibility verification tools that enable you to quickly move through your revenue cycle and efficiently communicate payer/patient payment responsibilities.

Ensure data accuracy and reduce resources

Data validation and optimization is a key component of accurate eligibility and claims processing workflows. Iguana’s validation-specific interfaces can help to ensure data accuracy and when paired with built-in error notifications and automatic monitoring, can lessen the need for manual intervention and reduce the strain on IT resources.

Securely exchange data between systems

Using industry-standard algorithms, Iguana ensures that your data remains secure throughout the data transaction process. The ability to configure user roles and capabilities within Iguana puts you in control, and adds another layer of protection to make sure that only those authorized to access your data have the ability to do so.

“Iguana has played a critical role in ensuring we submit clean claims and receive full reimbursements for our services. These interfaces were responsible for recovering a significant amount of potentially lost revenue.”

Jim Boyer

CIO, Rush Memorial Hospital

Related Resources

When Real-Time Communication is Mission Critical

Quest Group Case Study: Real-time data validation for big data

Revenue Recovery through Effective Integration

Case Study: Rush Memorial Hospital ensures consistent revenue recovery with Iguana