Healthcare payers (insurance companies, health plans, government programs) rely on enterprise platforms to manage eligibility, claims, compliance, and provider lifecycle management.
|
Department / Workflow |
Key Processes |
Enterprise Software Vendors (URLs) |
|
Enrollment & Eligibility |
Member onboarding, eligibility verification |
HealthEdge (https://www.healthedge.com), TriZetto QNXT (https://www.cognizant.com/trizetto), Plexis (https://www.plexishealth.com) |
|
Claims Management |
Adjudication, repair, payment integrity |
NewgenONE (https://newgensoft.com), Pega (https://www.pega.com), HealthEdge (https://www.healthedge.com) |
|
Provider Lifecycle Mgmt (PLM) |
Provider onboarding, credentialing |
NewgenONE (https://newgensoft.com), VerityStream (https://veritystream.com), symplr (https://www.symplr.com) |
|
Appeals & Grievances (A&G) |
Member/provider disputes, case tracking |
NewgenONE (https://newgensoft.com), Pega (https://www.pega.com) |
|
Care/Utilization/Disease Mgmt |
Care coordination, UM/CM/DM workflows |
ZeOmega (https://www.zeomega.com), Casenet TruCare (https://www.casenetllc.com) |
|
Compliance & Audit |
HIPAA, CMS, NCQA reporting |
Simplify Healthcare (https://www.simplifyhealthcare.com), NewgenONE (https://newgensoft.com) |
Hospitals, health systems, and independent physician groups leverage software platforms for patient care, scheduling, EHR management, and revenue cycle optimization.
|
Department / Workflow |
Key Processes |
Enterprise Software Vendors (URLs) |
|
EHR/EMR |
Clinical documentation, interoperability |
Epic (https://www.epic.com), Cerner/Oracle Health (https://www.oracle.com/health), Meditech (https://www.meditech.com) |
|
Scheduling & Appointments |
Patient access, calendar management |
athenahealth (https://www.athenahealth.com), Allscripts (https://www.allscripts.com) |
|
Revenue Cycle Management (RCM) |
Billing, claims, denial management |
Change Healthcare (https://www.changehealthcare.com), Waystar (https://www.waystar.com), Experian Health (https://www.experian.com/healthcare) |
|
Clinical Departments |
Oncology, cardiology, radiology workflows |
Philips IntelliSpace (https://www.philips.com/healthtech), GE Healthcare (https://www.gehealthcare.com) |
|
Diagnostic Imaging & Labs |
Radiology, pathology, lab workflows |
Siemens Healthineers (https://www.siemens-healthineers.com), Roche Diagnostics (https://diagnostics.roche.com) |
|
Care Coordination |
Interoperability, discharge planning |
Epic Care Everywhere (https://www.epic.com), Innovaccer (https://innovaccer.com) |
Pharmaceutical, biotech, and medical device firms depend on specialized platforms for clinical trials, regulatory compliance, manufacturing, and sales operations.
|
Department / Workflow |
Key Processes |
Enterprise Software Vendors (URLs) |
|
Clinical Trial Mgmt (CTMS) |
Trial planning, site mgmt, patient recruitment |
Medidata (https://www.medidata.com), Oracle Siebel CTMS (https://www.oracle.com/industries/life-sciences) |
|
Lab Mgmt (LIMS) |
Sample tracking, data integrity |
LabWare (https://www.labware.com), Thermo Fisher LIMS (https://www.thermofisher.com) |
|
Regulatory Affairs |
FDA submissions, compliance |
Veeva Vault RIM (https://www.veeva.com), ArisGlobal (https://www.arisglobal.com) |
|
Manufacturing (MES) |
Batch production, quality assurance |
Siemens Opcenter (https://www.plm.automation.siemens.com), Rockwell Automation (https://www.rockwellautomation.com) |
|
Enterprise Resource Planning (ERP) |
Finance, supply chain, HR |
SAP S/4HANA (https://www.sap.com), Oracle NetSuite (https://www.netsuite.com) |
|
Commercial & CRM |
Salesforce automation, KOL mgmt |
Veeva CRM (https://www.veeva.com), Salesforce Health Cloud (https://www.salesforce.com) |
Contact Details:
Monika Vashishtha
+1 (646) 734-6482
#HealthcareAI #DigitalHealth #HealthTech #AIInHealthcare #GenAI #AgenticAI #HealthcareInnovation #FutureOfHealthcare ; #HealthcarePayers #HealthSystems #PharmaTech #LifeSciencesAI #ProviderSolutions #PlatformEconomy #PayerProviderPharma ; #LowCode #Automation #WorkflowAutomation #ECM #BPM #CCM #DataDrivenCare #Interoperability ; #GHITDigital #NewgenOne #DigitalTransformation #HealthcareSoftware #IntelligentAutomation
