Network Security for GHIT Clients – A Point of View
Network Security for GHIT Clients – A Point of View Network security is the protection of networking infrastructure against unauthorized access, misuse, theft, or disruption. It encompasses policies, processes, and practices designed to prevent, detect, and respond to potential threats. By safeguarding systems, applications, and data, network security not only protects internal operations but also ensures customer trust by defending …
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Healthcare Payers (P1) Focused Enterprise Software Products & Platforms
Healthcare Payers (P1) Focused Enterprise Software Products & Platforms The U.S. healthcare payer ecosystem is one of the most complex in the world, with health plans managing claims, enrollment, billing, compliance, provider networks, and member engagement across millions of lives. Enterprise software products and platforms play a pivotal role in ensuring payers can deliver efficient, compliant, and member-centric services. Cognizant’s …
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The Future of Healthcare Payers and Facets: An Exclusive Q&A with Monika Vashishtha, President & COO, GHIT Digital
The Future of Healthcare Payers and Facets: An Exclusive Q&A with Monika Vashishtha, President & COO, GHIT Digital Healthcare in the United States is a trillion-dollar ecosystem with payers—health insurance companies—at the center of member services, claims adjudication, and regulatory compliance. With increasing complexity around Medicare, Medicaid, ACA, and commercial plans, payer organizations rely on advanced platforms like Cognizant’s TriZetto …
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Unlocking Low-Code Process Automation (BPM): Practical Applications in the Healthcare Payer Industry
Unlocking Low-Code Process Automation (BPM): Practical Applications in the Healthcare Payer Industry Healthcare payers face increasing challenges today, from higher claims volumes to stricter regulations and growing member expectations for quick, transparent service. Legacy systems, while robust, often lack the flexibility and speed to adapt to these pressures. This is where low-code Business Process Management (BPM) platforms provide a …
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NewgenOne Software: A Solution for Employee Benefits Firms
NewgenOne Software: A Solution for Employee Benefits Firms Introduction Employee Benefits (EB) firms play a crucial role in safeguarding workforce well-being by administering diverse programs, including Major Medical, Dental, Vision, and Workers' Compensation (WC). However, their workflows are often complex and challenging, leading to inefficiencies and potential compliance risks. Key Challenges in the Employee Benefits Sector …
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GHIT Digital POV: Bridging the Data Divide Between Payers and Providers
GHIT Digital POV: Bridging the Data Divide Between Payers and Providers By GHIT Digital Introduction The U.S. healthcare ecosystem is at a crossroads. Payers and providers are under immense pressure from regulatory reform, rising costs, and the accelerating shift toward value-based care (VBC). Yet one persistent challenge continues to undermine transformation: the inability to integrate claims, clinical, pharmacy, and …
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AI, GenAI, Agent AI, and Agentic AI in the Healthcare Payer World
AI, GenAI, Agent AI, and Agentic AI in the Healthcare Payer World The healthcare payer ecosystem in the United States is complex, encompassing insurance enrollment, eligibility verification, claims processing, care management, financial integrity, regulatory compliance, and member engagement. The growing adoption of AI-driven technologies is reshaping how payers operate, optimize workflows, and enhance member outcomes. From traditional AI to agentic …
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Healthcare Consulting for Payers, Providers, and Pharma by GHIT Digital
Healthcare Consulting for Payers, Providers, and Pharma by GHIT Digital Introduction The U.S. healthcare ecosystem—spanning Payers (health insurance companies, PBMs, Medicaid/Medicare administrators), Providers (hospital systems, health systems, IPAs, physician groups), and Pharma & Life Sciences & Med Devices companies—faces unprecedented pressure to optimize outcomes, reduce costs, and navigate complex regulatory landscapes. At GHIT Digital, we understand that consulting in …
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The Day Job of a COO in a Health Plan: Managing Core Applications and Operations By GHIT Digital
Running a modern health plan is not just about strategy—it’s about execution. The Chief Operating Officer (COO), EVP, or VP of Applications in a payer organization carries the responsibility of ensuring that daily operations, member services, and core applications run seamlessly. This role sits at the intersection of business, technology, compliance, and member experience, requiring a blend of operational rigor …
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Core Administrative Processing Systems (CAPS) in Healthcare: AI-Enabled Transformation
Core Administrative Processing Systems (CAPS) in Healthcare: AI-Enabled Transformation Executive Summary Core Administrative Processing Systems (CAPS) form the operational backbone of healthcare payers, driving claims adjudication, benefits administration, provider contracting, and compliance. Modern solutions such as TriZetto Facets, TriZetto QNXT, HealthEdge, Plexis, and HealthAxis go far beyond basic processing. They now serve as digital transformation platforms—streamlining operations, elevating member experiences, …
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