Data management solutions for healthcare
Strengthen member outcomes, simplify compliance, and maintain governance in your AI models.
Earn member trust and audit confidence with better data
Health plans that get data right deliver better care, pass audits, and deepen member loyalty. Reconcile claims faster, keep provider directories accurate, and govern every AI model your plan depends on with Precisely solutions.
Healthcare data management problems being solved today
CHALLENGEClaims and membership data won’t reconcile
A claim transforms incorrectly in transit. Membership records don’t match CMS. A subsidy payment can’t be verified. Each discrepancy costs time and creates audit exposure.
SOLUTIONCatch discrepancies before they hit downstream systems
Reduce manual review and compliance risk with automated reconciliation across claims, membership, and financial systems, so you identify errors before they create downstream impacts.
CUSTOMER STORYEnhanced compliance, visibility, and efficiency
A provider-sponsored health plan improved HEDIS scores and health plan reimbursement by eliminating duplicate member records.
CHALLENGEAuditors ask for data lineage you can’t produce
HIPAA, CMS Star Ratings, HEDIS, SOX, NAIC, and EU AI Act requirements keep expanding. When an examiner asks for named data owners and model provenance, you need a documented answer.
SOLUTIONGovern data with traceable lineage before the inquiry
Classify PHI, assign data owners, and trace lineage across systems with data governance and catalog solutions – so you build compliance evidence before the audit starts.
CUSTOMER STORYDecreased PHI breaches and fines
A nonprofit healthcare payer enhanced compliance with strict, costly Protected Health Information (PHI) rules, using real-time analysis and standardized reports.
CHALLENGEProvider directories are wrong and members know it
Inaccurate directories trigger CMS audits, No Surprises Act penalties, and member trust failures.
SOLUTIONValidate provider data across every network source
Improve network adequacy and care gap analysis with geocoding, master data management (MDM), and SDOH enrichment capabilities that keep provider locations, specialties, and network status current and compliant.
CUSTOMER STORYIdentifying care gaps with efficiency
A leading healthcare network cut mapping project time from days to an hour, using location intelligence to identify care gaps and plan network expansion.
CHALLENGEMembers don’t understand their plan options
Members who can’t navigate their plan options disengage, call in, or churn, at real cost to your plan.
SOLUTIONDeliver personalized plan selection that drives enrollment
Improve understanding and enrollment completion with customer communications solutions that deliver personalized, interactive videos that walk members through plan options at their own pace.
73% of viewers likely to choose a plan, after one video
See how Blue Shield of California simplifies plan selection for prospective members using personalized videos.
Accurate, secure patient data exchange
Smals made information exchange more efficient and reliable by governing data across Belgium’s national eHealth platform.
Moving from data problems to data confidence
Stop reconciliation failures
- Connect claims, membership, and financial data across every internal and external system with data integration capabilities that support crucial healthcare initiatives.
- Catch discrepancies automatically before they reach the general ledger or CMS reporting, supported by data reconciliation capabilities.
- Validate 834 enrollment data, subsidy payments, and vendor data before it impacts your business.
Build audit-ready data governance
- Classify PHI and assign named data owners across claims, membership, and financial systems.
- Support HIPAA, CMS, HEDIS, and AI model accountability by tracking data lineage.
- Enhance EU AI Act compliance with documented provenance for every dataset feeding your models.
What healthcare organizations get when their data is right
- Reduce audit and compliance risk with traceable data lineage
- Improve CMS Star Ratings and HEDIS scores with accurate member data
- Cut claims reconciliation cycle times with automated discrepancy detection
- Strengthen provider network accuracy and No Surprises Act compliance
- Build a governed data foundation for AI models and advanced analytics
- Improve enrollment and retention with personalized member communications
CUSTOMER STORYMitigating Insurance Risk
Enterprise claims and membership data reconciliation.
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Frequently asked questions
What healthcare data formats does Precisely integrate?
Precisely solutions integrate HL7, FHIR, X12, and proprietary file formats alongside data from mainframe, SAP, cloud, and on-premises systems. You get a unified, consistent view of claims, membership, provider, and financial data without forcing system migration.
How do data management solutions support CMS Star Ratings and HEDIS for healthcare providers?
Data quality and reconciliation capabilities from Precisely validate and cleanse member and clinical data against CMS and third-party sources. Accurate, complete records directly support HEDIS measure reporting and the data accuracy requirements underlying Star Ratings.
Can Precisely help us govern data used in AI models and stay compliant with AI legislation?
Yes. Precisely data governance capabilities track lineage, assigns data ownership, and documents quality rules for every dataset feeding your AI models. That evidence trail supports EU AI Act compliance and gives your CDO a defensible answer when a regulator asks who owns the data behind a decision.
How does Precisely support provider directory accuracy and No Surprises Act compliance?
Precisely geocoding and master data management capabilities validate provider locations, specialties, and network status from multiple sources. Automated reconciliation identifies discrepancies across credentialing, contracting, and member-facing directory systems before they trigger audit findings.
Does Precisely work with existing mainframe and SAP systems?
Yes. The Precisely Platform integrates across mainframe, SAP, cloud, and hybrid environments without migration. Healthcare organizations routinely use Precisely to move data from IBM Z and IBM i systems into modern analytics and governance platforms.